Healthcare Provider Details

I. General information

NPI: 1114852902
Provider Name (Legal Business Name): THOMAS CLANCY HIDALGO O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 VETERANS BLVD
DENHAM SPRINGS LA
70726-4724
US

IV. Provider business mailing address

38084 SPRINGWOOD AVE
PRAIRIEVILLE LA
70769-4287
US

V. Phone/Fax

Practice location:
  • Phone: 225-791-2020
  • Fax:
Mailing address:
  • Phone: 225-933-0621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2079-026AT
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: