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General NPI Number Information
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NPI Number | 1255127056
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Entity Type | Organization
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Legal Business Name | WILLIS KNIGHTON OPHTHALMOLOGY BOSSIER
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Dates
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Enumeration Date | 04/17/2025
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 2300 HOSPITAL DR STE 350
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City | BOSSIER CITY
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State | LA
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Zip | 71111-2179
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Country | US
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Telephone | 318-716-4891
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Fax |
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Provider Business Mailing Address
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Address Line | 2300 HOSPITAL DR STE 350
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City | BOSSIER CITY
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State | LA
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Zip | 71111-2179
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT OF FINANCE
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Name | MARY JANE WARD
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Credential |
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Telephone | 318-716-4891
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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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