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Organization
SOUTHERN RETINAL INSTITUTE, LLC
Active
Organization
SOUTHERN RETINAL INSTITUTE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RHONDA GARRISON CREDENTIALING (CREDENTIALING COORDINATOR)
(865) 584-2127
Entity
Organization
Contact information
Practice address
2800 VETERANS MEMORIAL BLVD STE 160, METAIRIE, LA 70002-6175
(504) 264-9428
(504) 264-9438
Mailing address
2800 VETERANS MEMORIAL BLVD STE 160, METAIRIE, LA 70002-6175
(504) 264-9472
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
202072
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1162353
—
LA
Enumeration date
10/26/2017
Last updated
01/31/2019
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