Healthcare Provider Details

I. General information

NPI: 1366611105
Provider Name (Legal Business Name): THOMAS VISION CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 06/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N 5TH ST
LEESVILLE LA
71446-2910
US

IV. Provider business mailing address

PO BOX 681
LEESVILLE LA
71496-0681
US

V. Phone/Fax

Practice location:
  • Phone: 337-239-2020
  • Fax: 337-239-0755
Mailing address:
  • Phone: 337-239-2020
  • Fax: 337-239-0755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CLIFTON MARK COWAN
Title or Position: OWNER
Credential: O.D.
Phone: 337-239-2020