Provider Demographics
NPI:1265642482
Name:O'SULLIVAN, PATRICK SEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:SEAN
Last Name:O'SULLIVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2800 VETERANS MEMORIAL BLVD STE 160
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-6175
Mailing Address - Country:US
Mailing Address - Phone:504-264-9428
Mailing Address - Fax:
Practice Address - Street 1:2800 VETERANS MEMORIAL BLVD STE 160
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-6175
Practice Address - Country:US
Practice Address - Phone:504-264-9428
Practice Address - Fax:504-264-9438
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18991207W00000X
LAMD202072207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01602071Medicaid
LA1162353Medicaid