Provider Demographics
NPI:1831282524
Name:WESTSIDE EYE CLINIC
Entity Type:Organization
Organization Name:WESTSIDE EYE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SONNIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-347-8434
Mailing Address - Street 1:4601 WICHERS DR
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3049
Mailing Address - Country:US
Mailing Address - Phone:504-347-8434
Mailing Address - Fax:504-347-9868
Practice Address - Street 1:4601 WICHERS DR
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3049
Practice Address - Country:US
Practice Address - Phone:504-347-8434
Practice Address - Fax:504-347-9868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1114928Medicaid
LA0420130001Medicare NSC
LA1114928Medicaid