Provider Demographics
NPI:1902940919
Name:FERTEL, ALAN (OD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:FERTEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4209 COURTLAND DR
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-3111
Mailing Address - Country:US
Mailing Address - Phone:504-456-9238
Mailing Address - Fax:
Practice Address - Street 1:5171 CITRUS BLVD
Practice Address - Street 2:SUITE 2040
Practice Address - City:HARAHAN
Practice Address - State:LA
Practice Address - Zip Code:70123-2342
Practice Address - Country:US
Practice Address - Phone:504-818-0669
Practice Address - Fax:504-818-2108
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1009-225T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist