Healthcare Provider Details

I. General information

NPI: 1558742585
Provider Name (Legal Business Name): ASHLEY'S OPTICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2015
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13131 PLANK RD
BAKER LA
70714
US

IV. Provider business mailing address

13131 PLANK RD
BAKER LA
70714-4914
US

V. Phone/Fax

Practice location:
  • Phone: 225-775-9406
  • Fax: 225-775-0258
Mailing address:
  • Phone: 225-775-9406
  • Fax: 225-775-0258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number StateNULL

VIII. Authorized Official

Name: ASHLEY MONIQUE WATERS
Title or Position: OWNER
Credential:
Phone: 225-775-9406