Organization Name: | WK PEDIATRIC EYE SPECIALISTS |
NPI Number: | 1548408628 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GREG J. GAVIN (NETWORK ADMINISTRATOR) |
Mailing Address: | 1202 Louisiana Ave Shreveport |
State: | LA US |
Postal Code: | 711013910 |
Phone Number: | 3182128946 |
Fax Number: | 3182124153 |
NPI Enumeration Date: | 01/28/2009 |
NPI Last Update Date: | 06/11/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |