=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043401516
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEOPLES CHOICE OPTICAL LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2007
-----------------------------------------------------
Last Update Date | 08/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2800 VETERANS MEMORIAL BLVD STE 125
-----------------------------------------------------
City | METAIRIE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70002-6130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-833-9041
-----------------------------------------------------
Fax | 504-832-9629
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2800 VETERANS MEMORIAL BLVD STE 125
-----------------------------------------------------
City | METAIRIE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70002-6130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-833-9041
-----------------------------------------------------
Fax | 504-832-9629
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | DR. KENNETH GEORGE HAIK
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 504-833-9041
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------