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General NPI Number Information
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NPI Number | 1316078173
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Entity Type | Organization
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Legal Business Name | EYE PROFESSIONALS, LLC
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 01/23/2013
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Provider Practice Location Address
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Address Line | 501 S LEWIS ST
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City | NEW IBERIA
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State | LA
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Zip | 70560-4818
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Country | US
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Telephone | 337-367-7777
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Fax |
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Provider Business Mailing Address
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Address Line | 501 S LEWIS ST
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City | NEW IBERIA
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State | LA
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Zip | 70560-4818
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Country | US
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Telephone | 337-367-7777
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. GRADY J. WILLIAMS
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Credential |
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Telephone | 337-367-7777
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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 | 787-335T
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License Number State | LA
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