MEDICARE: OBYRNE EYE CLINIC, L.L.C.

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
1	174400000X	Specialist	016256	LA

General Provider Information

NPI Number	:	1649471335
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OBYRNE EYE CLINIC, L.L.C.

Provider Business Mailing Address
First Line	:	1580 W CAUSEWAY APPROACH
Second Line	:	SUITE 3
City	:	MANDEVILLE
State	:	LA
Zip	:	70471-3033
Country	:	US
Telephone Number	:	985-624-5573
Fax Number	:	985-624-9106

Provider Business Practice Location Address
First Line	:	1580 W CAUSEWAY APPROACH
Second Line	:	SUITE 3
City	:	MANDEVILLE
State	:	LA
Zip	:	70471-3033
Country	:	US
Telephone Number	:	985-624-5573
Fax Number	:	985-624-9106

Authorized Official
Title or Position	:	OWNERM.D.
Name	:	MARILU OBYRNE
Credential	:	M.D.
Telephone Number	:	985-624-5573

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	04/12/2013

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