Healthcare Provider Details

I. General information

NPI: 1881697241
Provider Name (Legal Business Name): BARRY A BOHN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 GUILBEAU RD
LAFAYETTE LA
70506-8708
US

IV. Provider business mailing address

609 GUILBEAU RD
LAFAYETTE LA
70506-8708
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 Number10519
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: