Dr. Michael Wade Jorgensen Od LLC

NPI #1144677899 in Benton, Louisiana

Provider Information

NPI Number: 1144677899
Entity Type: Organization
Organization Name: Dr. Michael Wade Jorgensen Od LLC
Primary Specialty: Optometrist
Enumeration Date: May 23, 2016
Last Updated: May 23, 2016

Practice Location

Address: 187 BURT BLVD
Address 2: STE A
City: Benton
State: Louisiana
ZIP Code: 71006-4905
Phone: (318) 935-5080

Authorized Official

Name: DR. MICHAEL WADE JORGENSEN, OD
Title: OWNER/DOCTOR
Phone: (318) 935-5080

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Optometrist	152W00000X	Primary

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