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
—
—
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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