Healthcare Provider Details

I. General information

NPI: 1770832149
Provider Name (Legal Business Name): SCOTT EYE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2012
Last Update Date: 08/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5511 CAMERON ST
SCOTT LA
70583-5201
US

IV. Provider business mailing address

5511 CAMERON ST
SCOTT LA
70583-5201
US

V. Phone/Fax

Practice location:
  • Phone: 337-298-6293
  • Fax: 832-934-1161
Mailing address:
  • Phone: 337-298-6293
  • Fax: 832-934-1161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1609-642T
License Number StateLA

VIII. Authorized Official

Name: RAYAN A CAZARES
Title or Position: OWNER/OD
Credential: OD
Phone: 337-298-6293