Provider Demographics
NPI:1073550448
Name:YOUNG EYE CLINIC, A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:YOUNG EYE CLINIC, A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILE
Authorized Official - Middle Name:D
Authorized Official - Last Name:BROUSSARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-893-4452
Mailing Address - Street 1:204 N MAGDALEN SQ
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70510-4645
Mailing Address - Country:US
Mailing Address - Phone:337-893-4452
Mailing Address - Fax:337-893-7870
Practice Address - Street 1:204 N MAGDALEN SQ
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-4645
Practice Address - Country:US
Practice Address - Phone:337-893-4452
Practice Address - Fax:337-893-7870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA0583490001OtherDME