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Organization
WK EYE CENTER AT TOWNE OAKS
Active
Organization
WK EYE CENTER AT TOWNE OAKS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J. GAVIN (NETWORK ADMINISTRATOR)
(318) 212-8780
Entity
Organization
Contact information
Practice address
855 PIERREMONT RD, SUITE 102, SHREVEPORT, LA 71106-2040
(318) 213-3333
(318) 213-3332
Mailing address
855 PIERREMONT RD, SUITE 102, SHREVEPORT, LA 71106-2040
(318) 213-3333
(318) 213-3332
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
NULL
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
275381
MEDICARE PTAN
LA
Enumeration date
02/07/2013
Last updated
10/16/2013
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