Healthcare Provider Details

I. General information

NPI: 1144275017
Provider Name (Legal Business Name): THE RETINA INSTITUTE, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 09/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 N CAUSEWAY BLVD
METAIRIE LA
70002-6029
US

IV. Provider business mailing address

2701 N CAUSEWAY BLVD
METAIRIE LA
70002-6029
US

V. Phone/Fax

Practice location:
  • Phone: 504-455-0500
  • Fax: 504-455-3730
Mailing address:
  • Phone: 504-455-0500
  • Fax: 504-455-3730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number13621R
License Number StateLA

VIII. Authorized Official

Name: DR. SHEHAB A. EBRAHIM
Title or Position: PRINCIPAL PROVIDER
Credential: M.D.
Phone: 504-455-0500