| Wk Pediatric Eye Specialists | |
|
1202 Louisiana Ave Shreveport LA 71101-3910 | |
| (318) 212-8946 | |
| (318) 212-4153 |
| Full Name | Wk Pediatric Eye Specialists |
|---|---|
| Speciality | General Practice |
| Location | 1202 Louisiana Ave, Shreveport, Louisiana |
| Authorized Official Name and Position | Greg J. Gavin (NETWORK ADMINISTRATOR) |
| Authorized Official Contact | 3182124232 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wk Pediatric Eye Specialists 1202 Louisiana Ave Shreveport LA 71101-3910 Ph: (318) 212-8946 | Wk Pediatric Eye Specialists 1202 Louisiana Ave Shreveport LA 71101-3910 Ph: (318) 212-8946 |
| NPI Number | 1548408628 |
|---|---|
| Provider Enumeration Date | 01/28/2009 |
| Last Update Date | 06/11/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548408628 | NPI | - | NPPES |
| 1371815 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
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