# EYELID PLASTIC SURGERY & RECONSTRUCTIVE CENTER, LLC

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

## Provider details

- **NPI number:** 1841410230
- **Authorized official:** DR. KYLE V ACOSTA M.D. (OPHTHALMOLOGIST)
- **Authorized official phone:** (985) 898-2001

## Contact information

- **Practice address:** 200 GREENBRIAR BLVD, SUITE B, COVINGTON, LA 70433-7235
- **Practice address phone:** (985) 898-2001
- **Practice address fax:** (985) 898-2909
- **Mailing address:** 200 GREENBRIAR BLVD, SUITE B, COVINGTON, LA 70433-7235
- **Mailing address phone:** (985) 898-2001
- **Mailing address fax:** (985) 898-2909

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | 23847 | LA | Yes |

## Other

- **Enumeration date:** 04/26/2007
- **Last updated:** 04/30/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1443000 | — | LA |