Provider Demographics
NPI:1003350489
Name:CENTRAL OPHTHALMIC & MEDICAL BILLING SERVICES LLC
Entity Type:Organization
Organization Name:CENTRAL OPHTHALMIC & MEDICAL BILLING SERVICES LLC
Other - Org Name:OD COORDINATOR AND MEDICAL BILLING SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:C/O
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PICOU
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:504-655-7211
Mailing Address - Street 1:2900 WEST FORK DR
Mailing Address - Street 2:SUITE 401
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70827
Mailing Address - Country:US
Mailing Address - Phone:504-655-7211
Mailing Address - Fax:
Practice Address - Street 1:2900 WEST FORK DR
Practice Address - Street 2:SUITE 401
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70827
Practice Address - Country:US
Practice Address - Phone:504-867-7337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-05
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156F00000X, 156FX1202X, 156FX1800X, 251K00000X
LA251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251K00000XAgenciesPublic Health or Welfare
No156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Multi-Specialty
No156FX1202XEye and Vision Services ProvidersTechnician/TechnologistOptometric TechnicianGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty