MEDICARE: DILLINGHAM OPTICAL DISPENSARY, INC

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	:	1720137953
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DILLINGHAM OPTICAL DISPENSARY, INC

Provider Business Mailing Address
First Line	:	1812 ROSELAWN AVE
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71201-5434
Country	:	US
Telephone Number	:	318-387-1602
Fax Number	:	318-325-9425

Provider Business Practice Location Address
First Line	:	1812 ROSELAWN AVE
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71201-5434
Country	:	US
Telephone Number	:	318-387-1602
Fax Number	:	318-325-9425

Authorized Official
Title or Position	:	OWNER
Name	:	MR. BEN DILLINGHAM
Credential	:
Telephone Number	:	318-255-0817

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	03/21/2012

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