Healthcare Provider Details

I. General information

NPI: 1922674084
Provider Name (Legal Business Name): LAUREN AGNEW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2021
Last Update Date: 05/31/2021
Certification Date: 05/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 HIGHWAY 190 STE B
MANDEVILLE LA
70471-8632
US

IV. Provider business mailing address

3601 HIGHWAY 190 STE B
MANDEVILLE LA
70471-8632
US

V. Phone/Fax

Practice location:
  • Phone: 985-624-3314
  • Fax: 985-624-3601
Mailing address:
  • Phone: 985-624-3314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. LAUREN AGNEW
Title or Position: OWNER
Credential: OD
Phone: 985-624-3314