Provider Demographics
NPI:1083975510
Name:ALEXANDRIA EYE & LASER CENTER, LLC
Entity Type:Organization
Organization Name:ALEXANDRIA EYE & LASER CENTER, LLC
Other - Org Name:ALEXANDRIA EYE AND LASER CENTER NATCHITOCHES OPTICAL
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:NORTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-487-2020
Mailing Address - Street 1:231 WINDERMERE BLVD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3538
Mailing Address - Country:US
Mailing Address - Phone:318-487-2020
Mailing Address - Fax:318-443-9993
Practice Address - Street 1:118 SOUTH DR
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-5037
Practice Address - Country:US
Practice Address - Phone:877-861-7770
Practice Address - Fax:318-352-6860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-31
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.011191332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1441210Medicaid
LA1441210Medicaid