Provider Demographics
NPI:1083739387
Name:SONGY, BROCK JOACHIM (OD)
Entity Type:Individual
Prefix:DR
First Name:BROCK
Middle Name:JOACHIM
Last Name:SONGY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4114 MARIGNY ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-4931
Mailing Address - Country:US
Mailing Address - Phone:504-288-2333
Mailing Address - Fax:504-288-2227
Practice Address - Street 1:4114 MARIGNY ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122-4931
Practice Address - Country:US
Practice Address - Phone:504-288-2333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001889152W00000X
LA1546-581T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist