Healthcare Provider Details

I. General information

NPI: 1588103469
Provider Name (Legal Business Name): EYECARE SPECIALTIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2017
Last Update Date: 02/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

564 VALHI BLVD
HOUMA LA
70360
US

IV. Provider business mailing address

564 VALHI BLVD
HOUMA LA
70360
US

V. Phone/Fax

Practice location:
  • Phone: 985-876-6980
  • Fax: 985-876-6975
Mailing address:
  • Phone: 985-876-6980
  • Fax: 985-876-6975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1544-574AT
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number011428
License Number StateLA

VIII. Authorized Official

Name: DR. MARC ROLAND ARDOIN
Title or Position: OWNER
Credential:
Phone: 985-876-6980