Provider Demographics
NPI:1316362304
Name:GREATER NEW ORLEANS EYE CARE-DESTREHAN LLC
Entity Type:Organization
Organization Name:GREATER NEW ORLEANS EYE CARE-DESTREHAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:WILHITE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:615-653-8663
Mailing Address - Street 1:1 STOREHOUSE LANE
Mailing Address - Street 2:UNIT B
Mailing Address - City:DESTREHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70047
Mailing Address - Country:US
Mailing Address - Phone:504-348-2993
Mailing Address - Fax:
Practice Address - Street 1:1 STOREHOUSE LANE
Practice Address - Street 2:UNIT B
Practice Address - City:DESTREHAN
Practice Address - State:LA
Practice Address - Zip Code:70047
Practice Address - Country:US
Practice Address - Phone:504-348-2993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREATER NEW ORLEANS EYE CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1635-669T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty