DR. Manuel Mariano De La Rua O.D.

Overview of DR. Manuel Mariano De La Rua O.D.

• NPI number: 1063059160
• Provider type: Individual
• Specialty: Optometrist
• Gender: Male
• Active since: 05/19/2006
• Last updated: 09/30/2013

Primary Scrop of Practice

• Taxonomy Code: 152W00000X
• Specialty: Optometrist
• License Number: 992202T
• License State: LA

Provider Mailing Address

• Address: 3701 Williams Blvd
  Suite 204
  Kenner, LA 70065
• Phone: 504-443-9485
• Fax: 504-443-5834

Provider Practice Location

• Address: 3701 Williams Blvd
  Suite 204
  Kenner, LA 70065
• Phone: 504-443-9485
• Fax: 504-443-5834

Scope of Practice

• Taxonomy Code: 152W00000X
• Specialty: Optometrist
• License Number: 992202T
• License State: LA
• Switch: Yes

Legacy Identifiers

• Provider Identifier: 1910562
• Identifier Type: Medicare Oscar/Certification
• Identifier State: LA
• Issuer: