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NPI Code Detail

MEDICARE: CENTRAL EYE CARE COSMETIC CENTER AND OPTICAL, LLC

MEDICARE: CENTRAL EYE CARE COSMETIC CENTER AND OPTICAL, 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
1152W00000XOptometrist1560-592TLA

Other Identifiers

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

General Provider Information

NPI Number : 1336370618
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTRAL EYE CARE COSMETIC CENTER AND OPTICAL, LLC
Provider Business Mailing Address
First Line : 18522 MAGNOLIA BRIDGE RD STE A
Second Line :
City : GREENWELL SPRINGS
State : LA
Zip : 70739-4628
Country : US
Telephone Number : 225-261-6282
Fax Number : 225-261-6012
Provider Business Practice Location Address
First Line : 18522 MAGNOLIA BRIDGE RD STE A
Second Line :
City : GREENWELL SPRINGS
State : LA
Zip : 70739-4628
Country : US
Telephone Number : 225-261-6282
Fax Number : 225-261-6012
Authorized Official
Title or Position : OWNER
Name : DR. KEVIN A ROGERS
Credential : O. D.
Telephone Number : 225-261-6282
Provider Enumeration Date : 08/04/2009
Last Update Date : 01/25/2012

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Directions to “CENTRAL EYE CARE COSMETIC CENTER AND OPTICAL, LLC ” Practice Location

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