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General NPI Number Information
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NPI Number | 1154747780
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Entity Type | Organization
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Legal Business Name | DR. EDWARD G GILCREASE O.D., LLC
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Dates
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Enumeration Date | 03/06/2014
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Last Update Date | 04/24/2014
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Provider Practice Location Address
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Address Line | 1110 N 7TH ST
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City | WEST MONROE
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State | LA
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Zip | 71291-4334
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Country | US
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Telephone | 318-330-9070
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Fax |
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Provider Business Mailing Address
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Address Line | 101 COUNTRY ESTATES DR
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City | WEST MONROE
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State | LA
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Zip | 71291-9078
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. EDWARD GILCREASE
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Credential | O.D.
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Telephone | 318-330-9070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1398528T
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License Number State | LA
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