Healthcare Provider Details

I. General information

NPI: 1265642482
Provider Name (Legal Business Name): PATRICK SEAN O'SULLIVAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 VETERANS MEMORIAL BLVD STE 160
METAIRIE LA
70002-6175
US

IV. Provider business mailing address

2800 VETERANS MEMORIAL BLVD STE 160
METAIRIE LA
70002-6175
US

V. Phone/Fax

Practice location:
  • Phone: 504-264-9428
  • Fax: 504-264-9438
Mailing address:
  • Phone: 504-264-9428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number18991
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD202072
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: