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General NPI Number Information
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NPI Number | 1063983351
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Entity Type | Organization
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Legal Business Name | ALEXANDRIA EYE AND LASER CENTER, LLC
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Dates
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Enumeration Date | 12/11/2018
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Last Update Date | 01/19/2022
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Provider Practice Location Address
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Address Line | 1310 N 19TH ST
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City | MONROE
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State | LA
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Zip | 71201-5044
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Country | US
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Telephone | 318-388-2020
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Fax | 318-427-0181
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Provider Business Mailing Address
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Address Line | 231 WINDERMERE BLVD
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City | ALEXANDRIA
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State | LA
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Zip | 71303-3538
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Country | US
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Telephone | 318-561-0919
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Fax | 318-427-0181
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | OCTAVIA JACKSON WILLIAMS
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Credential |
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Telephone | 318-561-0946
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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