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General NPI Number Information
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NPI Number | 1497249361
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Entity Type | Organization
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Legal Business Name | OPTIMAL EYE CARE CENTER, L.L.C.
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Dates
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Enumeration Date | 06/14/2018
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Last Update Date | 07/10/2018
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Provider Practice Location Address
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Address Line | 20103 OLD SCENIC HWY STE 2B
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City | ZACHARY
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State | LA
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Zip | 70791
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Country | US
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Telephone | 225-570-2753
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Fax | 225-570-2758
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Provider Business Mailing Address
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Address Line | 809 SUMMER BREEZE DR APT 305
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City | BATON ROUGE
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State | LA
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Zip | 70810-6197
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Country | US
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Telephone | 225-570-2753
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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. PHONG QUOC TRAN
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Credential | OD
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Telephone | 337-251-6018
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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 | 1629662T
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License Number State | LA
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