Healthcare Provider Details

I. General information

NPI: 1144406000
Provider Name (Legal Business Name): JOHN CASANOVA ADVANCED HEARING AND VISION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2008
Last Update Date: 09/07/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 EAST 6TH STREET
CROWLEY LA
70526
US

IV. Provider business mailing address

P.O. BOX 1022
CROWLEY LA
70527-1022
US

V. Phone/Fax

Practice location:
  • Phone: 337-783-3075
  • Fax: 337-783-2548
Mailing address:
  • Phone: 337-783-3075
  • Fax: 337-783-2548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number1015
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name: JOHN M CASANOVA
Title or Position: OWNER
Credential:
Phone: 337-783-3075