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NPI Code Detail

MEDICARE: WK PEDIATRIC EYE SPECIALISTS

MEDICARE: WK PEDIATRIC EYE SPECIALISTS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208D00000XGeneral Practice Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1548408628
Entity Type Code : Organization
Provider Name (Legal Business Name) : WK PEDIATRIC EYE SPECIALISTS
Provider Business Mailing Address
First Line : 1202 LOUISIANA AVE
Second Line :
City : SHREVEPORT
State : LA
Zip : 71101-3910
Country : US
Telephone Number : 318-212-8946
Fax Number : 318-212-4153
Provider Business Practice Location Address
First Line : 1202 LOUISIANA AVE
Second Line :
City : SHREVEPORT
State : LA
Zip : 71101-3910
Country : US
Telephone Number : 318-212-8946
Fax Number : 318-212-4153
Authorized Official
Title or Position : NETWORK ADMINISTRATOR
Name : GREG J. GAVIN
Credential :
Telephone Number : 318-212-4232
Provider Enumeration Date : 01/28/2009
Last Update Date : 06/11/2012

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Directions to “WK PEDIATRIC EYE SPECIALISTS ” Practice Location

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