Healthcare Provider Details

I. General information

NPI: 1356344790
Provider Name (Legal Business Name): JOSEPH & SWAN EYE CENTER, A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 11/01/2025
Certification Date: 11/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 SOUTHCITY PKWY STE 101
LAFAYETTE LA
70503-5718
US

IV. Provider business mailing address

214 SOUTHCITY PKWY STE 101
LAFAYETTE LA
70503-5718
US

V. Phone/Fax

Practice location:
  • Phone: 337-981-6430
  • Fax: 337-981-9134
Mailing address:
  • Phone: 337-981-6430
  • Fax: 337-981-9134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateLA

VIII. Authorized Official

Name: DARLEEN ROMERO THIBODEAUX
Title or Position: PRACTICE MANAGER
Credential:
Phone: 337-981-6430