Healthcare Provider Details

I. General information

NPI: 1568430924
Provider Name (Legal Business Name): PATRICK R. MAGEE O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5605 AMBASSADOR CAFFERY PKWY STE 100
YOUNGSVILLE LA
70592-5180
US

IV. Provider business mailing address

4510 AMBASSADOR CAFFERY PKWY SUITE A
LAFAYETTE LA
70508-6931
US

V. Phone/Fax

Practice location:
  • Phone: 337-984-2020
  • Fax: 337-989-0374
Mailing address:
  • Phone: 337-984-2020
  • Fax: 337-989-0374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number916-070T
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: