Provider Demographics
NPI:1659356392
Name:LASER & CATARACT CENTER OF SHREVEPORT LLC
Entity Type:Organization
Organization Name:LASER & CATARACT CENTER OF SHREVEPORT LLC
Other - Org Name:EYE SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RN MANAGER ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:L
Authorized Official - Last Name:ALFORD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:318-869-1130
Mailing Address - Street 1:445 ASHLEY RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-7229
Mailing Address - Country:US
Mailing Address - Phone:318-869-1130
Mailing Address - Fax:318-865-8499
Practice Address - Street 1:445 ASHLEY RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106
Practice Address - Country:US
Practice Address - Phone:318-869-1130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA122261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1527211Medicaid
LA1160563Medicaid
LA1160563Medicaid