Healthcare Provider Details

I. General information

NPI: 1689107062
Provider Name (Legal Business Name): ST. TAMMANY EYE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 VILLAGE WALK
COVINGTON LA
70433-4006
US

IV. Provider business mailing address

1107 VILLAGE WALK
COVINGTON LA
70433-4006
US

V. Phone/Fax

Practice location:
  • Phone: 985-231-0800
  • Fax: 985-590-3721
Mailing address:
  • Phone: 985-231-0800
  • Fax: 985-590-3721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number1603-636AT
License Number StateLA

VIII. Authorized Official

Name: DR. AMANDA N HICKMAN
Title or Position: OWNER
Credential: OD
Phone: 985-231-0800