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General NPI Number Information
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NPI Number | 1750639043
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Entity Type | Organization
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Legal Business Name | THE LENS SOURCE
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Dates
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Enumeration Date | 08/17/2012
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 5237 JONES CREEK RD
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City | BATON ROUGE
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State | LA
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Zip | 70817-2124
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Country | US
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Telephone | 225-755-3937
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Fax | 225-755-2272
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Provider Business Mailing Address
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Address Line | 5237 JONES CREEK RD
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City | BATON ROUGE
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State | LA
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Zip | 70817-2124
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Country | US
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Telephone | 225-755-3937
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Fax | 225-755-2272
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. SHEILA SMITH CRAWFORD
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Credential | ABO
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Telephone | 225-892-0450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State | LA
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