Provider Demographics
NPI:1538120985
Name:ALEXANDRIA EYE AND LASER CENTER, LLC
Entity Type:Organization
Organization Name:ALEXANDRIA EYE AND LASER CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF QUALITY & COMPLIANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:OCTAVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:CREDENTIALING
Authorized Official - Phone:318-561-0946
Mailing Address - Street 1:231 WINDERMERE BLVD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3538
Mailing Address - Country:US
Mailing Address - Phone:318-487-2020
Mailing Address - Fax:318-445-7745
Practice Address - Street 1:231 WINDERMERE BLVD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3538
Practice Address - Country:US
Practice Address - Phone:318-487-2020
Practice Address - Fax:318-445-7745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC4592OtherTRAVELERS MEDICARE
LA1441210Medicaid
DC4592OtherTRAVELERS MEDICARE