Healthcare Provider Details

I. General information

NPI: 1992709885
Provider Name (Legal Business Name): THE RETINAL INSTITUTE OF LOUISIANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10001 LAKE FOREST BLVD STE 701
NEW ORLEANS LA
70127-5264
US

IV. Provider business mailing address

10001 LAKE FOREST BLVD STE 701
NEW ORLEANS LA
70127-5264
US

V. Phone/Fax

Practice location:
  • Phone: 504-246-1966
  • Fax: 504-241-0743
Mailing address:
  • Phone: 504-246-1966
  • Fax: 504-241-0743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number072372
License Number StateLA

VIII. Authorized Official

Name: DR. DAVID ANTHONY NEWSOME
Title or Position: CEO
Credential: M.D.
Phone: 504-246-1966