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Organization
DR. MICHAEL WADE JORGENSEN OD LLC
Active
Organization
DR. MICHAEL WADE JORGENSEN OD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL WADE JORGENSEN OD (OWNER/DOCTOR)
(318) 935-5080
Entity
Organization
Contact information
Practice address
187 BURT BLVD, STE A, BENTON, LA 71006-4905
(318) 935-5080
(318) 935-5085
Mailing address
187 BURT BLVD, STE A, BENTON, LA 71006-4905
(318) 935-5080
(318) 935-5085
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1590623T
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2394495
—
LA
Enumeration date
05/23/2016
Last updated
05/23/2016
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