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General NPI Number Information
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NPI Number | 1396068045
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Entity Type | Organization
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Legal Business Name | MENARD EYE CENTER, L.L.C.
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Dates
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Enumeration Date | 03/10/2010
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Last Update Date | 03/10/2010
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Provider Practice Location Address
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Address Line | 4448 LAKE ST
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City | LAKE CHARLES
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State | LA
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Zip | 70605-4312
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Country | US
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Telephone | 337-842-8344
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Fax | 337-439-0185
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Provider Business Mailing Address
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Address Line | 4448 LAKE ST
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City | LAKE CHARLES
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State | LA
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Zip | 70605-4312
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Country | US
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Telephone | 337-842-8344
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Fax | 337-439-0185
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Authorized Official
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Title or Position | OWNER/MANAGER/OPTOMETRIST
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Name | DR. KEITH MICHEAL MENARD
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Credential | O.D.
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Telephone | 337-842-8344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 1369-514T
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License Number State | LA
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