Provider Demographics
NPI:1053422113
Name:EYE MEDICAL CENTER, APMC
Entity type:Organization
Organization Name:EYE MEDICAL CENTER, APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:J
Authorized Official - Last Name:LANDRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-766-7441
Mailing Address - Street 1:7777 HENNESSY BLVD
Mailing Address - Street 2:SUITE 4000
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-0306
Mailing Address - Country:US
Mailing Address - Phone:225-766-7441
Mailing Address - Fax:225-766-7597
Practice Address - Street 1:7777 HENNESSY BLVD
Practice Address - Street 2:SUITE 4000
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-0306
Practice Address - Country:US
Practice Address - Phone:225-766-7441
Practice Address - Fax:225-766-7597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA979137T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LACS3812OtherRR MEDICARE
LA1791849Medicaid
LA5B969Medicare PIN
LA1791849Medicaid