Organization
DR. MICHAEL WADE JORGENSEN OD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL WADE JORGENSEN OD (OWNER/DOCTOR)
(318) 935-5080
Entity
Organization
Contact information
Practice address
187 BURT BLVD, STE A, BENTON, LA 71006-4905
(318) 935-5080
(318) 935-5085
Mailing address
187 BURT BLVD, STE A, BENTON, LA 71006-4905
(318) 935-5080
(318) 935-5085
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1590623T
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2394495
—
LA
Enumeration date
05/23/2016
Last updated
05/23/2016
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