Provider Demographics
NPI:1255335121
Name:HINRICHSEN, JOHN D (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:HINRICHSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 E. BERT KOUNS
Mailing Address - Street 2:SUITE #103
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5634
Mailing Address - Country:US
Mailing Address - Phone:318-222-8402
Mailing Address - Fax:318-222-4556
Practice Address - Street 1:1400 E BERT KOUNS LOOP
Practice Address - Street 2:SUITE #103
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5634
Practice Address - Country:US
Practice Address - Phone:318-222-8402
Practice Address - Fax:318-222-4556
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA025484207W00000X
LAMD.025484207WX0110X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1578304Medicaid
TX8F5258OtherTEXAS MEDICARE NUMBER
LA1053315846OtherGROUP NPI NUMBER
AR160135001OtherARKANSAS MEDICAID NUMBER
TX166932702OtherTEXAS MEDICAID NUMBER
TX8F5258OtherTEXAS MEDICARE NUMBER
LA1053315846OtherGROUP NPI NUMBER
LA4F8366742Medicare PIN