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General NPI Number Information
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NPI Number | 1326015751
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Entity Type | Individual
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Provider Name | EARL JOSEPH PRIMO O. D.
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Gender | Male
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Dates
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Enumeration Date | 03/03/2006
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Last Update Date | 03/11/2019
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Provider Practice Location Address
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Address Line | 880 N HIGHWAY 190
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City | COVINGTON
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State | LA
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Zip | 70433-5147
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Country | US
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Telephone | 985-867-8708
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Fax | 985-867-8711
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Provider Business Mailing Address
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Address Line | 205 STONEWOOD DR
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City | COVINGTON
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State | LA
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Zip | 70433-5819
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Country | US
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Telephone | 504-606-1701
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Fax | 985-871-9953
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1332-466T
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License Number State | LA
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