Provider Demographics
NPI:1811942824
Name:BOSSIER OPHTHALMOLOGY CLINIC AMC
Entity type:Organization
Organization Name:BOSSIER OPHTHALMOLOGY CLINIC AMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PLAUCHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-212-7860
Mailing Address - Street 1:2400 HOSPITAL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2385
Mailing Address - Country:US
Mailing Address - Phone:318-212-7860
Mailing Address - Fax:318-212-7865
Practice Address - Street 1:2400 HOSPITAL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2385
Practice Address - Country:US
Practice Address - Phone:318-212-7860
Practice Address - Fax:318-212-7865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1811942824Medicare NSC
LA5CW59Medicare PIN