Provider Demographics
NPI:1306364070
Name:WYATT, DAVID RAYMOND (BCO)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:RAYMOND
Last Name:WYATT
Suffix:
Gender:M
Credentials:BCO
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Other - First Name:
Other - Middle Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2800 VETERANS MEMORIAL BLVD.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002
Mailing Address - Country:US
Mailing Address - Phone:504-522-2354
Mailing Address - Fax:
Practice Address - Street 1:2800 VETERANS MEMORIAL BLVD.
Practice Address - Street 2:SUITE 200
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002
Practice Address - Country:US
Practice Address - Phone:504-522-2354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-01
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularist