Provider Demographics
NPI:1104014216
Name:GERMER HALEY LLC
Entity Type:Organization
Organization Name:GERMER HALEY LLC
Other - Org Name:EYE SURGERY CENTER OF LOUISIANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILIAM
Authorized Official - Middle Name:DAVE
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-455-1816
Mailing Address - Street 1:3900 VETERANS MEMORIAL BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-5634
Mailing Address - Country:US
Mailing Address - Phone:504-455-1816
Mailing Address - Fax:504-887-7816
Practice Address - Street 1:409 AVENUE F
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-3633
Practice Address - Country:US
Practice Address - Phone:985-735-8137
Practice Address - Fax:504-887-7816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015514Medicaid
LA1441121Medicaid
MS00134738Medicaid
LACH3022Medicare PIN
MS09015514Medicaid