Healthcare Provider Details

I. General information

NPI: 1437024825
Provider Name (Legal Business Name): ANNIE RACHAL GREMILLION
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2025
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 CANAL ST
NEW ORLEANS LA
70112-3018
US

IV. Provider business mailing address

2250 LEESTOWN RD
LEXINGTON KY
40511-1052
US

V. Phone/Fax

Practice location:
  • Phone: 504-702-4200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2458DT
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: