Healthcare Provider Details

I. General information

NPI: 1548233794
Provider Name (Legal Business Name): METAIRIE OPHTHALMOLOGY ASC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 VETERANS MEMORIAL BLVD SUITE 100
METAIRIE LA
70002-5634
US

IV. Provider business mailing address

3900 VETERANS MEMORIAL BLVD SUITE 100
METAIRIE LA
70002-5634
US

V. Phone/Fax

Practice location:
  • Phone: 504-455-1550
  • Fax: 504-455-2011
Mailing address:
  • Phone: 504-455-1550
  • Fax: 504-455-2011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number94
License Number StateLA

VIII. Authorized Official

Name: MR. ROBERT JOHNSON
Title or Position: SECRETARY/TREASURER
Credential:
Phone: 504-512-2161