Provider Demographics
NPI:1790381069
Name:LOUISIANA EYE AND LASER
Entity Type:Organization
Organization Name:LOUISIANA EYE AND LASER
Other - Org Name:LOUISIANA EYE AND LASER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING TEAM LEAD
Authorized Official - Prefix:
Authorized Official - First Name:SHUNDRICKA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-487-2020
Mailing Address - Street 1:231 WINDERMERE BLVD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3538
Mailing Address - Country:US
Mailing Address - Phone:318-487-2020
Mailing Address - Fax:318-427-0173
Practice Address - Street 1:231 WINDERMERE BLVD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3538
Practice Address - Country:US
Practice Address - Phone:318-487-2020
Practice Address - Fax:318-427-0173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1441210Medicaid