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General NPI Number Information
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NPI Number | 1437320405
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Entity Type | Organization
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Legal Business Name | EYEMAX FAMILY OPTICAL
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Dates
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Enumeration Date | 03/18/2008
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Last Update Date | 03/18/2008
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Provider Practice Location Address
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Address Line | 11424 SULLIVAN RD BLDG A SUITE A
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City | BATON ROUGE
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State | LA
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Zip | 70818-3615
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Country | US
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Telephone | 225-262-8141
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Fax | 225-262-8142
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Provider Business Mailing Address
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Address Line | 11424 SULLIVAN RD BLDG A SUITE A
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City | BATON ROUGE
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State | LA
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Zip | 70818-3615
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Country | US
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Telephone | 225-262-8141
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Fax | 225-262-8142
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Authorized Official
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Title or Position | OPTICAL STORE MANAGER
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Name | MS. DONNA LYNN DECKER
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Credential |
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Telephone | 225-262-8141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 6872006003
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License Number State | LA
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