Provider Demographics
NPI:1497263545
Name:NORTHSHORE EYE CLINIC
Entity Type:Organization
Organization Name:NORTHSHORE EYE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:210-739-4098
Mailing Address - Street 1:221 S AMERICA ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-3527
Mailing Address - Country:US
Mailing Address - Phone:210-739-4098
Mailing Address - Fax:985-641-1353
Practice Address - Street 1:181 NORTHSHORE BLVD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70460-6821
Practice Address - Country:US
Practice Address - Phone:986-641-1331
Practice Address - Fax:985-641-1353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1855-789AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty