Provider Demographics
NPI:1588653893
Name:MCCOMISKEY, EMMETT COLIN (MD)
Entity Type:Individual
Prefix:DR
First Name:EMMETT
Middle Name:COLIN
Last Name:MCCOMISKEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 W 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-3308
Mailing Address - Country:US
Mailing Address - Phone:985-871-0070
Mailing Address - Fax:985-871-0046
Practice Address - Street 1:604 W 13TH AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-3308
Practice Address - Country:US
Practice Address - Phone:985-871-0070
Practice Address - Fax:985-871-0046
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA021469207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAP00314749OtherRAILROAD MEDICARE PIN
LA1661546Medicaid
LAG08605Medicare UPIN
LA5W263Medicare PIN