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General NPI Number Information
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NPI Number | 1639458573
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Entity Type | Organization
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Legal Business Name | EXTENDED EYECARE SERVICES, LLC
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Dates
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Enumeration Date | 08/10/2011
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Last Update Date | 08/10/2011
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Provider Practice Location Address
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Address Line | 101 STRATFORD DR
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City | LAFAYETTE
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State | LA
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Zip | 70503-5062
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Country | US
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Telephone | 337-781-3709
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Fax | 337-534-8252
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Provider Business Mailing Address
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Address Line | 101 STRATFORD DR
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City | LAFAYETTE
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State | LA
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Zip | 70503-5062
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Country | US
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Telephone | 337-781-3709
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Fax | 337-534-8252
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL LLOYD ZIEGLER
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Credential | O.D.
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Telephone | 337-781-3709
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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 | 1283443T
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License Number State | LA
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