=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750589750
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LARRY J. CAMINITA, O.D. (APC)
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2007
-----------------------------------------------------
Last Update Date | 06/01/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1111 MEDICAL CENTER BLVD SUITE 111
-----------------------------------------------------
City | MARRERO
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70072-3151
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-347-6330
-----------------------------------------------------
Fax | 504-347-6338
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1111 MEDICAL CENTER BLVD SUITE 111
-----------------------------------------------------
City | MARRERO
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70072-3151
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-347-6330
-----------------------------------------------------
Fax | 504-347-6338
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/OPTOMETRIST
-----------------------------------------------------
Name | LARRY JOHN CAMINITA
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 504-347-6330
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 859216T
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------