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General NPI Number Information
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NPI Number | 1679979694
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Entity Type | Organization
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Legal Business Name | ALICIA P CROOKS, A PROFESSIONAL OPTOMETRY LLC
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Dates
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Enumeration Date | 11/19/2014
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Last Update Date | 11/19/2014
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Provider Practice Location Address
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Address Line | 2536 AIRLINE DR
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City | BOSSIER CITY
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State | LA
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Zip | 71111-5813
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Country | US
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Telephone | 318-623-1664
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Fax |
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Provider Business Mailing Address
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Address Line | 134 DOGWOOD SOUTH LN
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City | HAUGHTON
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State | LA
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Zip | 71037-7512
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Country | US
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Telephone | 318-623-1664
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. ALICIA K CROOKS
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Credential | OD
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Telephone | 318-623-1664
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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 | 1558-590T
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License Number State | LA
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