# LOUISIANA RETINA A PROFESSIONAL MEDICAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235738634
- **Authorized official:** JORDAN BURNHAM MD (OWNER)
- **Authorized official phone:** (225) 523-7624

## Contact information

- **Practice address:** 303 VETERANS BLVD STE A, DENHAM SPRINGS, LA 70726-4723
- **Practice address phone:** (225) 242-9729
- **Mailing address:** 303 VETERANS BLVD STE A, DENHAM SPRINGS, LA 70726-4723
- **Mailing address phone:** (225) 242-9729

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |
| 207WX0107X | Retina Specialist (Ophthalmology) Physician | — | NULL | — |
| 207WX0107X | Retina Specialist (Ophthalmology) Physician | — | — | — |

## Other

- **Enumeration date:** 10/19/2020
- **Last updated:** 05/18/2022