Provider Demographics
NPI:1083772453
Name:O'BYRNE, MARILU (MD)
Entity Type:Individual
Prefix:DR
First Name:MARILU
Middle Name:
Last Name:O'BYRNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 W CAUSEWAY APPROACH
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-3033
Mailing Address - Country:US
Mailing Address - Phone:985-624-5573
Mailing Address - Fax:985-624-9106
Practice Address - Street 1:1580 W CAUSEWAY APPROACH
Practice Address - Street 2:SUITE 3
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3033
Practice Address - Country:US
Practice Address - Phone:985-624-5573
Practice Address - Fax:985-624-9106
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA016256207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1318850Medicaid
LAB62268Medicare UPIN
LA502476690Medicare PIN