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General NPI Number Information
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NPI Number | 1831234673
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Entity Type | Organization
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Legal Business Name | ELITE EYEWEAR, INC
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 02/20/2008
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Provider Practice Location Address
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Address Line | 4848 NORTH BLVD
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City | BATON ROUGE
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State | LA
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Zip | 70806-4019
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Country | US
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Telephone | 225-923-3865
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Fax | 225-927-0130
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Provider Business Mailing Address
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Address Line | 4848 NORTH BLVD
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City | BATON ROUGE
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State | LA
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Zip | 70806-4019
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Country | US
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Telephone | 225-923-3865
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Fax | 225-927-0130
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Authorized Official
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Title or Position | OWNER
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Name | MRS. NENA H MONTAGNINO
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Credential |
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Telephone | 225-923-3865
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 7944200-001
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License Number State | LA
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