Healthcare Provider Details

I. General information

NPI: 1649471335
Provider Name (Legal Business Name): OBYRNE EYE CLINIC, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 04/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 W CAUSEWAY APPROACH SUITE 3
MANDEVILLE LA
70471-3033
US

IV. Provider business mailing address

1580 W CAUSEWAY APPROACH SUITE 3
MANDEVILLE LA
70471-3033
US

V. Phone/Fax

Practice location:
  • Phone: 985-624-5573
  • Fax: 985-624-9106
Mailing address:
  • Phone: 985-624-5573
  • Fax: 985-624-9106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number016256
License Number StateLA

VIII. Authorized Official

Name: MARILU OBYRNE
Title or Position: OWNERM.D.
Credential: M.D.
Phone: 985-624-5573