Provider Demographics
NPI:1902370034
Name:OPTEO LABORATORY, LLC
Entity Type:Organization
Organization Name:OPTEO LABORATORY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:
Authorized Official - Last Name:LIDSTONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-766-8477
Mailing Address - Street 1:935 GRAVIER ST STE 520
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-1687
Mailing Address - Country:US
Mailing Address - Phone:504-766-8477
Mailing Address - Fax:504-208-5734
Practice Address - Street 1:1441 CANAL ST STE 401
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2714
Practice Address - Country:US
Practice Address - Phone:504-827-1801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-11
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory