# JARED VINCENT MD RUSTON EYE INSTITUTE LLC

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

## Provider details

- **NPI number:** 1619189362
- **Authorized official:** JARED MARK VINCENT M.D. (OWNER)
- **Authorized official phone:** (318) 251-0620

## Contact information

- **Practice address:** 400 E VAUGHN AVE, RUSTON, LA 71270-5951
- **Practice address phone:** (318) 251-0620
- **Mailing address:** 400 E VAUGHN AVE, RUSTON, LA 71270-5951
- **Mailing address phone:** (318) 251-0620

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | 025302 | LA | Yes |

## Other

- **Enumeration date:** 05/04/2007
- **Last updated:** 11/19/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1578967 | — | LA |
| 01 | — | 1639167836 | INDIVIDUAL NPI | LA |
| 01 | — | 4K576CY25 | MEDICARE INDIVIDUAL \# | LA |