Provider Demographics
NPI:1164516340
Name:LAHAYE, PHILIP A (OD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:A
Last Name:LAHAYE
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 1:7400 YOUREE DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5536
Mailing Address - Country:US
Mailing Address - Phone:318-524-1400
Mailing Address - Fax:
Practice Address - Street 1:7020 YOUREE DR STE A
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5109
Practice Address - Country:US
Practice Address - Phone:318-524-1400
Practice Address - Fax:318-524-1900
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA865-082T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1303698Medicaid
LA47602Medicare ID - Type Unspecified
LA1303698Medicaid