Healthcare Provider Details

I. General information

NPI: 1811305949
Provider Name (Legal Business Name): JONATHAN ERIK SCOGIN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2014
Last Update Date: 08/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1804 N 7TH ST
WEST MONROE LA
71291-4414
US

IV. Provider business mailing address

1804 N 7TH ST
WEST MONROE LA
71291-4414
US

V. Phone/Fax

Practice location:
  • Phone: 318-325-2610
  • Fax: 318-325-7715
Mailing address:
  • Phone: 318-325-2610
  • Fax: 318-325-7715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number1777-711T
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: