Provider Demographics
NPI:1851305205
Name:SCHNEIDER, ELLEN C (MD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:C
Last Name:SCHNEIDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2364 GAUSE BLVD. E.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-4126
Mailing Address - Country:US
Mailing Address - Phone:985-781-7531
Mailing Address - Fax:985-781-7538
Practice Address - Street 1:2364 GAUSE BLVD. E.
Practice Address - Street 2:SUITE 101
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-4126
Practice Address - Country:US
Practice Address - Phone:985-781-7531
Practice Address - Fax:985-781-7538
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD019143207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAMD019143OtherMEDICAL LICENSE
LA18170OtherSTATE CDS
LA1917036Medicaid
LA5N470Medicare ID - Type Unspecified
LA1917036Medicaid