Healthcare Provider Details

I. General information

NPI: 1508104167
Provider Name (Legal Business Name): DR. SMITH'S EYE CARE & OPTICAL LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2013
Last Update Date: 09/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12656 JEFFERSON HWY
BATON ROUGE LA
70816-6240
US

IV. Provider business mailing address

12656 JEFFERSON HWY
BATON ROUGE LA
70816-6240
US

V. Phone/Fax

Practice location:
  • Phone: 225-751-4100
  • Fax: 225-751-4103
Mailing address:
  • Phone: 225-751-4100
  • Fax: 225-751-4103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number621000
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code156FX1202X
TaxonomyOptometric Technician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DANIEL SMITH
Title or Position: OWNER
Credential:
Phone: 225-751-4100