Healthcare Provider Details

I. General information

NPI: 1164597761
Provider Name (Legal Business Name): OUTPATIENT EYE SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 12/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4324 VETERANS MEMORIAL BLVD SUITE 101
METAIRIE LA
70006-5445
US

IV. Provider business mailing address

DEPT AT 952520
ATLANTA GA
31192-2520
US

V. Phone/Fax

Practice location:
  • Phone: 504-455-4046
  • Fax: 504-883-7669
Mailing address:
  • Phone: 504-455-4046
  • Fax: 504-883-7669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number35
License Number StateLA

VIII. Authorized Official

Name: DR. RONALD A LANDRY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 504-455-4046