Provider Demographics
NPI:1477698454
Name:REGIONAL EYE SURGERY CENTER,LLC
Entity Type:Organization
Organization Name:REGIONAL EYE SURGERY CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ASHLEE
Authorized Official - Middle Name:HARDIN
Authorized Official - Last Name:DUGAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-214-6688
Mailing Address - Street 1:7777 HENNESSY BLVD
Mailing Address - Street 2:SUITE 5000
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4300
Mailing Address - Country:US
Mailing Address - Phone:225-214-6688
Mailing Address - Fax:225-214-6687
Practice Address - Street 1:7777 HENNESSY BLVD
Practice Address - Street 2:SUITE 5000
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4300
Practice Address - Country:US
Practice Address - Phone:225-214-6688
Practice Address - Fax:225-214-6687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA103261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1103250Medicaid
LA20142OtherBLUE CROSS BLUE SHIELD
LA11075Medicare PIN