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General NPI Number Information
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NPI Number | 1073550448
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Entity Type | Organization
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Legal Business Name | YOUNG EYE CLINIC, A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 06/02/2006
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Last Update Date | 06/09/2015
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Provider Practice Location Address
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Address Line | 204 N MAGDALEN SQ
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City | ABBEVILLE
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State | LA
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Zip | 70510-4645
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Country | US
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Telephone | 337-893-4452
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Fax | 337-893-7870
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Provider Business Mailing Address
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Address Line | 204 N MAGDALEN SQ
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City | ABBEVILLE
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State | LA
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Zip | 70510-4645
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Country | US
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Telephone | 337-893-4452
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Fax | 337-893-7870
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Authorized Official
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Title or Position | OWNER
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Name | EMILE D BROUSSARD
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Credential | MD
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Telephone | 337-893-4452
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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