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General NPI Number Information
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NPI Number | 1841410230
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Entity Type | Organization
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Legal Business Name | EYELID PLASTIC SURGERY & RECONSTRUCTIVE CENTER, LLC
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 04/30/2008
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Provider Practice Location Address
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Address Line | 200 GREENBRIAR BLVD SUITE B
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City | COVINGTON
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State | LA
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Zip | 70433-7235
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Country | US
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Telephone | 985-898-2001
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Fax | 985-898-2909
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Provider Business Mailing Address
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Address Line | 200 GREENBRIAR BLVD SUITE B
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City | COVINGTON
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State | LA
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Zip | 70433-7235
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Country | US
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Telephone | 985-898-2001
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Fax | 985-898-2909
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Authorized Official
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Title or Position | OPHTHALMOLOGIST
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Name | DR. KYLE V ACOSTA
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Credential | M.D.
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Telephone | 985-898-2001
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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 | 23847
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License Number State | LA
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