Basic Information
| Provider Information | |||||||||
| NPI: | 1407224421 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EAST JEFFERSON FAMILY PRACTICE, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PRECISION OPTICAL OF NEW ORLEANS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3848 VETERANS MEMORIAL BLVD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252057060 | ||||||||
| FaxNumber: | 5048852510 | ||||||||
| Practice Location | |||||||||
| Address1: | 3848 VETERANS MEMORIAL BLVD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252057060 | ||||||||
| FaxNumber: | 5048852510 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2015 | ||||||||
| LastUpdateDate: | 09/08/2015 | ||||||||
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| AuthorizedOfficialLastName: | HOANG | ||||||||
| AuthorizedOfficialFirstName: | ALEX | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5048852505 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.