MEDICARE: THE RETINAL INSTITUTE OF LOUISIANA

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	207W00000X	Ophthalmology Physician	072372	LA

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
2	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	:	1992709885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE RETINAL INSTITUTE OF LOUISIANA

Provider Business Mailing Address
First Line	:	10001 LAKE FOREST BLVD
Second Line	:	STE 701
City	:	NEW ORLEANS
State	:	LA
Zip	:	70127-5264
Country	:	US
Telephone Number	:	504-246-1966
Fax Number	:	504-241-0743

Provider Business Practice Location Address
First Line	:	10001 LAKE FOREST BLVD
Second Line	:	STE 701
City	:	NEW ORLEANS
State	:	LA
Zip	:	70127-5264
Country	:	US
Telephone Number	:	504-246-1966
Fax Number	:	504-241-0743

Authorized Official
Title or Position	:	CEO
Name	:	DR. DAVID ANTHONY NEWSOME
Credential	:	M.D.
Telephone Number	:	504-246-1966

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	08/22/2020

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Directions to “THE RETINAL INSTITUTE OF LOUISIANA ” Practice Location

Language	Start Address	Practice Location

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