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General NPI Number Information
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NPI Number | 1043645666
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Entity Type | Organization
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Legal Business Name | ADVANCED EYECARE, LLC
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Dates
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Enumeration Date | 09/13/2013
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Last Update Date | 12/16/2014
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Provider Practice Location Address
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Address Line | 107 CENTRE SARCELLE BLVD. SUITE 704
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City | YOUNGSVILLE
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State | LA
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Zip | 70592
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Country | US
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Telephone | 337-451-4511
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Fax | 337-857-6044
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Provider Business Mailing Address
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Address Line | 107 CENTRE SARCELLE BLVD. SUITE 704
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City | YOUNGSVILLE
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State | LA
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Zip | 70592
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Country | US
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Telephone | 337-451-4511
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Fax | 337-857-6044
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Authorized Official
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Title or Position | OPTOMETRIST, CEO
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Name | DR. GARY J GRANGER
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Credential | OD
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Telephone | 337-451-4511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 1611-644T
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License Number State | LA
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