Healthcare Provider Details

I. General information

NPI: 1427425883
Provider Name (Legal Business Name): ANU GUPTA DESAI, M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2015
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 HOSPITAL DR., STE 300
LAFAYETTE LA
70503
US

IV. Provider business mailing address

155 HOSPITAL DR., STE 300
LAFAYETTE LA
70503
US

V. Phone/Fax

Practice location:
  • Phone: 337-235-6263
  • Fax: 337-234-9629
Mailing address:
  • Phone: 337-235-6263
  • Fax: 337-234-9629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number203090
License Number StateLA

VIII. Authorized Official

Name: DR. ANU GUPTA DESAI
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 337-235-6263