Healthcare Provider Details

I. General information

NPI: 1619957347
Provider Name (Legal Business Name): VISUAL CARE & CONTACT LENS CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5917 JACKSON STREET
ALEXANDRIA LA
71303
US

IV. Provider business mailing address

5917 JACKSON STREET
ALEXANDRIA LA
71303
US

V. Phone/Fax

Practice location:
  • Phone: 318-445-5292
  • Fax: 318-448-9627
Mailing address:
  • Phone: 318-445-5292
  • Fax: 318-448-9627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number798123T
License Number StateLA

VIII. Authorized Official

Name: DR. CORNEL H LEBLANC
Title or Position: OWNER
Credential: OD
Phone: 318-445-5292