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General NPI Number Information
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NPI Number | 1962564351
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Entity Type | Organization
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Legal Business Name | EVANGELINE OPTICAL INC.
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 11/05/2014
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Provider Practice Location Address
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Address Line | 306A N LEWIS ST
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City | NEW IBERIA
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State | LA
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Zip | 70563-2843
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Country | US
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Telephone | 337-365-4893
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Fax | 337-365-4894
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Provider Business Mailing Address
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Address Line | 306A N LEWIS ST
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City | NEW IBERIA
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State | LA
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Zip | 70563-2843
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Country | US
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Telephone | 337-365-4893
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Fax | 337-365-4894
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Authorized Official
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Title or Position | OWNER
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Name | MR. TIM HOFFPAUIR
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Credential |
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Telephone | 337-365-4893
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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 |
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