Provider Demographics
NPI:1407392939
Name:SHIRLEY OGA KOECK OD LLC
Entity Type:Organization
Organization Name:SHIRLEY OGA KOECK OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:OGA
Authorized Official - Last Name:KOECK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:818-321-6608
Mailing Address - Street 1:3726 JEAN PL
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-4510
Mailing Address - Country:US
Mailing Address - Phone:818-321-6608
Mailing Address - Fax:818-638-7377
Practice Address - Street 1:3726 JEAN PL
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-4510
Practice Address - Country:US
Practice Address - Phone:818-321-6608
Practice Address - Fax:818-638-7377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-08
Last Update Date:2017-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1621-654T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty