=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437329034
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 4 YOUR EYES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2008
-----------------------------------------------------
Last Update Date | 09/20/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3221 N CAUSEWAY BLVD SUITE 101
-----------------------------------------------------
City | METAIRIE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-737-3456
-----------------------------------------------------
Fax | 504-738-3456
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3221 N CAUSEWAY BLVD SUITE 101
-----------------------------------------------------
City | METAIRIE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-737-3456
-----------------------------------------------------
Fax | 504-738-3456
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | NEIL NOTAROBERTO
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 985-624-5058
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | L10157R
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207WX0107X
-----------------------------------------------------
Taxonomy Name | Retina Specialist (Ophthalmology) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------