MEDICARE: GRAND VISION LAFRENIERE, L.L.C.

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	152W00000X	Optometrist	869112T	LA

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	:	1427356062
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAND VISION LAFRENIERE, L.L.C.

Provider Business Mailing Address
First Line	:	6601 VETERANS MEMORIAL BLVD
Second Line	:	STE 19 - 21
City	:	METAIRIE
State	:	LA
Zip	:	70003-3943
Country	:	US
Telephone Number	:	504-322-7525
Fax Number	:	504-322-7529

Provider Business Practice Location Address
First Line	:	6601 VETERANS MEMORIAL BLVD
Second Line	:	STE 19 - 21
City	:	METAIRIE
State	:	LA
Zip	:	70003-3943
Country	:	US
Telephone Number	:	504-322-7525
Fax Number	:	504-322-7529

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHN MUSSELMAN
Credential	:	O.D.
Telephone Number	:	504-322-7525

Provider Enumeration Date	:	03/07/2011
Last Update Date	:	02/21/2014

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Directions to “GRAND VISION LAFRENIERE, L.L.C. ” Practice Location

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