Basic Information
| Provider Information | |||||||||
| NPI: | 1205286408 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EYE AND RETINA CENTER OF BATON ROUGE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5242 CLAYCUT RD | ||||||||
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| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708067125 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 8585 PICARDY AVE | ||||||||
| Address2: | MEDICAL TOWER 2, SUITE 510 | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708093748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257634000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2016 | ||||||||
| LastUpdateDate: | 06/17/2016 | ||||||||
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| AuthorizedOfficialLastName: | HATCHER | ||||||||
| AuthorizedOfficialFirstName: | JAMIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2256361822 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 207066 | LA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.