Provider Demographics
NPI:1649285040
Name:FALGOUST EYE MEDICAL AND SURGICAL
Entity type:Organization
Organization Name:FALGOUST EYE MEDICAL AND SURGICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:FALGOUST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-477-0963
Mailing Address - Street 1:PO BOX 4765
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70606-4765
Mailing Address - Country:US
Mailing Address - Phone:337-477-0963
Mailing Address - Fax:337-477-1912
Practice Address - Street 1:1980 TYBEE LANE
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-2400
Practice Address - Country:US
Practice Address - Phone:337-477-0963
Practice Address - Fax:337-477-1912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD12137R207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1695807Medicaid
LA435194099BOtherBCBS
LA1695807Medicaid
G47552Medicare UPIN