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836 Olive St, Shreveport, LA 71104-2102 | |
(318) 222-8421 | |
(318) 673-8970 |
Full Name | |
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Type | Facility |
Speciality | Ophthalmology |
Location | 836 Olive St, Shreveport, Louisiana |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1689789562 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | (* (Not Available)) | Primary |
207W00000X | Ophthalmology | (* (Not Available)) | Primary |
Provider Name | Charles E Lyon |
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Provider Type | Practitioner - Ophthalmology |
Provider Identifiers | NPI Number: 1558380303 PECOS PAC ID: 8820025711 Enrollment ID: I20050722000082 |
Provider Name | Neil W Brogden |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1265545644 PECOS PAC ID: 9739281924 Enrollment ID: I20070219000239 |
Provider Name | Jessica Renee Trichel |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1376899633 PECOS PAC ID: 2365698768 Enrollment ID: I20140804001202 |
Provider Name | Karen Evelyn Dumesnil |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1558978700 PECOS PAC ID: 5193144384 Enrollment ID: I20201008000980 |
Mailing Address | Practice Location Address |
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836 Olive St, Shreveport, LA 71104-2102 Ph: (318) 222-8421 | 836 Olive St, Shreveport, LA 71104-2102 Ph: (318) 222-8421 |