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General NPI Number Information
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NPI Number | 1730611039
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Entity Type | Organization
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Legal Business Name | ASHLEY VISION CENTER, LLC
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Dates
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Enumeration Date | 03/28/2017
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Last Update Date | 03/28/2017
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Provider Practice Location Address
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Address Line | 13131 PLANK RD
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City | BAKER
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State | LA
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Zip | 70714-4914
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Country | US
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Telephone | 225-775-9406
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Fax | 225-775-0258
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Provider Business Mailing Address
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Address Line | 13131 PLANK RD
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City | BAKER
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State | LA
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Zip | 70714-4914
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Country | US
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Telephone | 225-775-9406
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Fax | 225-775-0258
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Authorized Official
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Title or Position | CO-OWNER
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Name | ASHLEY MONIQUE WATERS
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Credential |
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Telephone | 225-775-9406
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 1014
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License Number State | LA
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