Healthcare Provider Details

I. General information

NPI: 1760413983
Provider Name (Legal Business Name): LARRY GEOFFROY O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 01/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S MAIN ST STE E
SAINT MARTINVILLE LA
70582-4544
US

IV. Provider business mailing address

400 S MAIN ST STE E
SAINT MARTINVILLE LA
70582-4544
US

V. Phone/Fax

Practice location:
  • Phone: 337-394-5595
  • Fax: 337-394-5597
Mailing address:
  • Phone: 337-394-5595
  • Fax: 337-394-5597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number959-228T
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: