Healthcare Provider Details

I. General information

NPI: 1811033376
Provider Name (Legal Business Name): MR. JOHN M CASANOVA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 12/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 E 6TH ST
CROWLEY LA
70526-4503
US

IV. Provider business mailing address

PO BOX 1022
CROWLEY LA
70527-1022
US

V. Phone/Fax

Practice location:
  • Phone: 337-783-3073
  • Fax: 337-783-2548
Mailing address:
  • Phone: 337-783-3073
  • Fax: 337-783-2548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1015
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: