MEDICARE: DR. EDWARD G GILCREASE O.D., LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1398528T	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154747780
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. EDWARD G GILCREASE O.D., LLC

Provider Business Mailing Address
First Line	:	101 COUNTRY ESTATES DR
Second Line	:
City	:	WEST MONROE
State	:	LA
Zip	:	71291-9078
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1110 N 7TH ST
Second Line	:
City	:	WEST MONROE
State	:	LA
Zip	:	71291-4334
Country	:	US
Telephone Number	:	318-330-9070
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR/OWNER
Name	:	DR. EDWARD GILCREASE
Credential	:	O.D.
Telephone Number	:	318-330-9070

Provider Enumeration Date	:	03/06/2014
Last Update Date	:	04/24/2014

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