Healthcare Provider Details

I. General information

NPI: 1104935204
Provider Name (Legal Business Name): ATLAS OPTICAL DISPENSARY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4560 NORTH BLVD
BATON ROUGE LA
70806-4043
US

IV. Provider business mailing address

4560 NORTH BLVD
BATON ROUGE LA
70806-4043
US

V. Phone/Fax

Practice location:
  • Phone: 225-927-4837
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: DEANNA B ALBERS
Title or Position: OFFICE MANAGER
Credential:
Phone: 225-927-4837