Highland Clinic, a Prof Med Corp

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

Legal business name

HIGHLAND CLINIC, A PROF MED CORP

Practice address

1400 E Bert Koun Loop
#103
Shreveport, LA 71105-5603

Phone

(318) 222-8402

Fax

(318) 222-4556

NPI assigned

Nov 2, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Michael Gustavson

Title

Administrator

Phone

(318) 798-4465

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1446422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1780358400000",
    "number": "1891168761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1455 E BERT KOUN LOOP",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055634",
            "telephone_number": "318-798-4500",
            "fax_number": "318-798-4555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 E BERT KOUN LOOP",
            "address_2": "#103",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055603",
            "telephone_number": "318-222-8402",
            "fax_number": "318-222-4556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HIGHLAND CLINIC, A PROF MED CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-02",
        "last_updated": "2026-06-02",
        "certification_date": "2026-06-02",
        "status": "A",
        "authorized_official_last_name": "GUSTAVSON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "318-798-4465",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "LA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1038300",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Ophthalmology Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Ophthalmology Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.