Organization
JARED VINCENT MD RUSTON EYE INSTITUTE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JARED MARK VINCENT M.D. (OWNER)
(318) 251-0620
Entity
Organization
Contact information
Practice address
400 E VAUGHN AVE, RUSTON, LA 71270-5951
(318) 251-0620
Mailing address
400 E VAUGHN AVE, RUSTON, LA 71270-5951
(318) 251-0620
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
025302
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1578967
—
LA
01
—
1639167836
INDIVIDUAL NPI
LA
01
—
4K576CY25
MEDICARE INDIVIDUAL #
LA
Enumeration date
05/04/2007
Last updated
11/19/2007
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