Provider Demographics
NPI:1356344790
Name:JOSEPH & SWAN EYE CENTER, A PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:JOSEPH & SWAN EYE CENTER, A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BROUSSARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-981-6430
Mailing Address - Street 1:214 SOUTHCITY PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-5718
Mailing Address - Country:US
Mailing Address - Phone:337-981-6430
Mailing Address - Fax:337-981-9134
Practice Address - Street 1:214 SOUTHCITY PKWY STE 101
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-5718
Practice Address - Country:US
Practice Address - Phone:337-981-6430
Practice Address - Fax:337-981-9134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1356344790OtherUNITED HEALTH CARE
LA1356344790OtherAMERICAN LIFECARE
LA1356344790OtherBESTCARE
LA1356344790OtherPHCS
LA1356344790OtherVERITY
LA1356344790OtherCOVENTRY
LA1356344790OtherST. EMPLOYEES GROUP
LA1356344790OtherMULTI PLAN
LA1356344790OtherGILSBAR 360
LA1356344790OtherBLUE CROSS & BLUE SHIELD OF LOUISIANA
LA1356344790OtherPPO PLUS
LA1356344790OtherAMERICAN LIFECARE
LA1356344790OtherGILSBAR 360
LA1356344790OtherMULTI PLAN