Provider Demographics
NPI:1225086689
Name:SEVERN EYECARE INC.
Entity Type:Organization
Organization Name:SEVERN EYECARE INC.
Other - Org Name:ST. CHARLES VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:BANK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:504-887-2020
Mailing Address - Street 1:3200 SEVERN AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-4793
Mailing Address - Country:US
Mailing Address - Phone:504-887-2020
Mailing Address - Fax:504-887-7698
Practice Address - Street 1:3200 SEVERN AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-4793
Practice Address - Country:US
Practice Address - Phone:504-887-2020
Practice Address - Fax:504-887-7698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA930-108T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA0326850001Medicare NSC