Healthcare Provider Details

I. General information

NPI: 1275525107
Provider Name (Legal Business Name): STEVEN G ZEGAR O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date: 03/23/2006
Reactivation Date: 03/29/2006

III. Provider practice location address

3088 GAUSE BLVD E
SLIDELL LA
70461-4155
US

IV. Provider business mailing address

3088 GAUSE BLVD E
SLIDELL LA
70461-4155
US

V. Phone/Fax

Practice location:
  • Phone: 985-641-6464
  • Fax:
Mailing address:
  • Phone: 985-641-6464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number758-188T
License Number StateLA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1156221
Identifier TypeMEDICAID
Identifier StateLA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: