Provider Demographics
NPI:1043470594
Name:HOTH EYE CLINIC, LLC
Entity Type:Organization
Organization Name:HOTH EYE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REBA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PLAISANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-768-7777
Mailing Address - Street 1:7777 HENNESSY BLVD
Mailing Address - Street 2:SUITE 5000
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4300
Mailing Address - Country:US
Mailing Address - Phone:225-768-7777
Mailing Address - Fax:225-214-3400
Practice Address - Street 1:7777 HENNESSY BLVD
Practice Address - Street 2:SUITE 5000
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4300
Practice Address - Country:US
Practice Address - Phone:225-768-7777
Practice Address - Fax:225-214-3400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA010934174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1153818Medicaid
MS15473Medicaid
LA1153818Medicaid