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Organization
JARED VINCENT MD RUSTON EYE INSTITUTE LLC
Active
Organization
JARED VINCENT MD RUSTON EYE INSTITUTE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JARED MARK VINCENT M.D. (OWNER)
(318) 251-0620
Entity
Organization
Contact information
Practice address
400 E VAUGHN AVE, RUSTON, LA 71270-5951
(318) 251-0620
Mailing address
400 E VAUGHN AVE, RUSTON, LA 71270-5951
(318) 251-0620
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
025302
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1578967
—
LA
01
—
1639167836
INDIVIDUAL NPI
LA
01
—
4K576CY25
MEDICARE INDIVIDUAL #
LA
Enumeration date
05/04/2007
Last updated
11/19/2007
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