Provider Demographics
NPI:1760606818
Name:EYE CENTER OF ST BERNARD
Entity Type:Organization
Organization Name:EYE CENTER OF ST BERNARD
Other - Org Name:THE EYE CENTER OF ST BERNARD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SCHOENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-279-5266
Mailing Address - Street 1:901 W JUDGE PEREZ DR
Mailing Address - Street 2:
Mailing Address - City:CHALMETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70043-4701
Mailing Address - Country:US
Mailing Address - Phone:504-279-5266
Mailing Address - Fax:504-271-0882
Practice Address - Street 1:901 W JUDGE PEREZ DR
Practice Address - Street 2:
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-4701
Practice Address - Country:US
Practice Address - Phone:504-279-5266
Practice Address - Fax:504-271-0882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA013842207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1941450Medicaid
LA57249Medicare PIN