Healthcare Provider Details

I. General information

NPI: 1154553071
Provider Name (Legal Business Name): NOEL SCOTT TAYLOR OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2009
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2434 HIGHWAY 171
STONEWALL LA
71078-9420
US

IV. Provider business mailing address

405 POLK ST
MANSFIELD LA
71052-2421
US

V. Phone/Fax

Practice location:
  • Phone: 318-925-2345
  • Fax: 318-925-3456
Mailing address:
  • Phone: 318-423-9807
  • Fax: 318-872-0748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1575-608T
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: