MEDICARE: SLIDELL EYE SPECIALISTS, APMC

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	152W00000X	Optometrist
2	207W00000X	Ophthalmology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CC9303	OTHER		RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1861517054
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SLIDELL EYE SPECIALISTS, APMC

Provider Business Mailing Address
First Line	:	2050 GAUSE BLVD E STE 150
Second Line	:
City	:	SLIDELL
State	:	LA
Zip	:	70461-5414
Country	:	US
Telephone Number	:	985-649-0206
Fax Number	:	985-649-4060

Provider Business Practice Location Address
First Line	:	2053 GAUSE BLVD E STE 100
Second Line	:
City	:	SLIDELL
State	:	LA
Zip	:	70461-5452
Country	:	US
Telephone Number	:	985-649-0206
Fax Number	:	985-649-4060

Authorized Official
Title or Position	:	MANAGER
Name	:	MICHAEL BRENNER
Credential	:
Telephone Number	:	985-249-0206

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	02/03/2026

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Practice Location Address:

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Directions to “SLIDELL EYE SPECIALISTS, APMC ” Practice Location

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