Provider Demographics
NPI:1164597761
Name:OUTPATIENT EYE SURGERY CENTER
Entity Type:Organization
Organization Name:OUTPATIENT EYE SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:LANDRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-455-4046
Mailing Address - Street 1:DEPT AT 952520
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31192-2520
Mailing Address - Country:US
Mailing Address - Phone:504-455-4046
Mailing Address - Fax:504-883-7669
Practice Address - Street 1:4324 VETERANS MEMORIAL BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-5445
Practice Address - Country:US
Practice Address - Phone:504-455-4046
Practice Address - Fax:504-883-7669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA35261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1377538Medicaid
LA1697958Medicaid
LA11028Medicare PIN