Healthcare Provider Details

I. General information

NPI: 1447429022
Provider Name (Legal Business Name): ALEXANDRIA EYE AND LASER CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 S 6TH ST
LEESVILLE LA
71446-4920
US

IV. Provider business mailing address

231 WINDERMERE BLVD
ALEXANDRIA LA
71303-3538
US

V. Phone/Fax

Practice location:
  • Phone: 337-392-1994
  • Fax: 337-392-1944
Mailing address:
  • Phone: 318-487-2020
  • Fax: 318-445-7745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: OCTAVIA JACKSON WILLIAMS
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 318-561-0946