MEDICARE: ATLAS OPTICAL DISPENSARY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104935204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLAS OPTICAL DISPENSARY, LLC

Provider Business Mailing Address
First Line	:	4560 NORTH BLVD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-4043
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4560 NORTH BLVD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-4043
Country	:	US
Telephone Number	:	225-927-4837
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	DEANNA B ALBERS
Credential	:
Telephone Number	:	225-927-4837

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	05/19/2008

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Directions to “ATLAS OPTICAL DISPENSARY, LLC ” Practice Location

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