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General NPI Number Information
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NPI Number | 1164956827
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Entity Type | Organization
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Legal Business Name | OCCUCARE INTERNATIONAL LAFAYETTE
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Dates
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Enumeration Date | 04/19/2017
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Last Update Date | 04/19/2017
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Provider Practice Location Address
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Address Line | 1028 FORUM DR
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City | BROUSSARD
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State | LA
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Zip | 70518-8060
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Country | US
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Telephone | 337-704-0891
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Fax | 337-704-0924
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Provider Business Mailing Address
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Address Line | 1028 FORUM DR
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City | BROUSSARD
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State | LA
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Zip | 70518-8060
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Country | US
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Telephone | 337-704-0891
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Fax | 337-704-0924
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | DR. MICHAEL L ODINET
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Credential | M.D.
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Telephone | 337-704-0920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD.025999
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License Number State | LA
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