MEDICARE: LANETTE M. GREEN, O.D., L.L.C.

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

General Provider Information

NPI Number	:	1316579444
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LANETTE M. GREEN, O.D., L.L.C.

Provider Business Mailing Address
First Line	:	706 RUE DE ONETTA
Second Line	:
City	:	NEW IBERIA
State	:	LA
Zip	:	70563-2108
Country	:	US
Telephone Number	:	337-251-6349
Fax Number	:

Provider Business Practice Location Address
First Line	:	607 RUE DE BRILLE
Second Line	:
City	:	NEW IBERIA
State	:	LA
Zip	:	70563-2169
Country	:	US
Telephone Number	:	337-367-1247
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPTOMETRIST
Name	:	DR. LANETTE M GREEN
Credential	:	O.D.
Telephone Number	:	337-251-6349

Provider Enumeration Date	:	02/06/2020
Last Update Date	:	02/06/2020

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