Provider Demographics
NPI:1609028968
Name:HART EYE CENTER, LLC
Entity Type:Organization
Organization Name:HART EYE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:BEROEN
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-439-4014
Mailing Address - Street 1:1920 WEST SALE ROAD
Mailing Address - Street 2:BLDG. F, STE. 3
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-5362
Mailing Address - Country:US
Mailing Address - Phone:337-439-4014
Mailing Address - Fax:337-439-0185
Practice Address - Street 1:1727 IMPERIAL BLVD
Practice Address - Street 2:BLDG. 1, STE. B
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5362
Practice Address - Country:US
Practice Address - Phone:337-439-4014
Practice Address - Fax:337-439-0185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-17
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1378801Medicaid