Provider Demographics
NPI:1649471335
Name:OBYRNE EYE CLINIC, L.L.C.
Entity type:Organization
Organization Name:OBYRNE EYE CLINIC, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNERM.D.
Authorized Official - Prefix:
Authorized Official - First Name:MARILU
Authorized Official - Middle Name:
Authorized Official - Last Name:OBYRNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-624-5573
Mailing Address - Street 1:1580 W CAUSEWAY APPROACH
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-3033
Mailing Address - Country:US
Mailing Address - Phone:985-624-5573
Mailing Address - Fax:985-624-9106
Practice Address - Street 1:1580 W CAUSEWAY APPROACH
Practice Address - Street 2:SUITE 3
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3033
Practice Address - Country:US
Practice Address - Phone:985-624-5573
Practice Address - Fax:985-624-9106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA016256174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA56690Medicare PIN