Healthcare Provider Details

I. General information

NPI: 1205766920
Provider Name (Legal Business Name): MORGAN GILLIS CORNNER OD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 SAM HOUSTON JONES PKWY STE 200
LAKE CHARLES LA
70611-5471
US

IV. Provider business mailing address

1355 SAM HOUSTON JONES PKWY STE 200
LAKE CHARLES LA
70611-5471
US

V. Phone/Fax

Practice location:
  • Phone: 337-426-9180
  • Fax:
Mailing address:
  • Phone: 337-426-9180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: MORGAN CORNNER
Title or Position: OWNER
Credential: O.D.
Phone: 337-426-9180