=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780964726
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOTS&TEENSEYECARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2011
-----------------------------------------------------
Last Update Date | 08/22/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3350 RIDGELAKE DR SUITE 200
-----------------------------------------------------
City | METAIRIE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70002-3836
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-828-4136
-----------------------------------------------------
Fax | 504-835-4281
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3350 RIDGELAKE DR SUITE 200
-----------------------------------------------------
City | METAIRIE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70002-3836
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-828-4136
-----------------------------------------------------
Fax | 504-835-4281
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. BRENDA KAY BISHOP
-----------------------------------------------------
Credential | CEO
-----------------------------------------------------
Telephone | 504-828-4136
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------