Provider Demographics
NPI:1548233794
Name:METAIRIE OPHTHALMOLOGY ASC LLC
Entity Type:Organization
Organization Name:METAIRIE OPHTHALMOLOGY ASC LLC
Other - Org Name:AMBULATORY EYE SURGERY CENTER OF LOUISIANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-512-2161
Mailing Address - Street 1:3900 VETERANS MEMORIAL BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-5634
Mailing Address - Country:US
Mailing Address - Phone:504-455-1550
Mailing Address - Fax:504-455-2011
Practice Address - Street 1:3900 VETERANS MEMORIAL BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-5634
Practice Address - Country:US
Practice Address - Phone:504-455-1550
Practice Address - Fax:504-455-2011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA94261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1698725Medicaid
MS09077052Medicaid
LA=========001OtherHUMANA MILITARY HEALTHCAR
LA=========001OtherHUMANA MILITARY HEALTHCAR
LA490004857Medicare PIN
LA11053Medicare PIN