| Gentilly Vision Source | |
|
4114 Marigny St New Orleans LA 70122-4931 | |
| (504) 288-2333 | |
| (504) 288-2227 |
| Full Name | Gentilly Vision Source |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 4114 Marigny St, New Orleans, Louisiana |
| Authorized Official Name and Position | Michael Kleamenakis (OWNER) |
| Authorized Official Contact | 5042882333 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gentilly Vision Source 4114 Marigny St New Orleans LA 70122-4931 Ph: (504) 288-2333 | Gentilly Vision Source 4114 Marigny St New Orleans LA 70122-4931 Ph: (504) 288-2333 |
| NPI Number | 1780907782 |
|---|---|
| Provider Enumeration Date | 03/04/2010 |
| Last Update Date | 12/12/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780907782 | NPI | - | NPPES |
| 1370142 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | 1030-060T (Louisiana) | Primary |
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