Healthcare Provider Details

I. General information

NPI: 1891879821
Provider Name (Legal Business Name): THE VISUAL DIFFERENCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 04/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 N TRENTON ST
RUSTON LA
71270-3805
US

IV. Provider business mailing address

303 N TRENTON ST
RUSTON LA
71270-3805
US

V. Phone/Fax

Practice location:
  • Phone: 318-202-5845
  • Fax: 318-202-5847
Mailing address:
  • Phone: 318-202-5845
  • Fax: 318-202-5847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number1285-436T
License Number StateLA

VIII. Authorized Official

Name: DR. JENNIFER ANN FLOYD
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 318-202-5845