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NPI Code Detail

MEDICARE: EYE CARE AND COSMETIC CENTER, LLC

MEDICARE: EYE CARE AND COSMETIC CENTER, 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
1152W00000XOptometrist

General Provider Information

NPI Number : 1346368412
Entity Type Code : Organization
Provider Name (Legal Business Name) : EYE CARE AND COSMETIC CENTER, LLC
Provider Business Mailing Address
First Line : 2421 CHURCH ST
Second Line :
City : ZACHARY
State : LA
Zip : 70791-2710
Country : US
Telephone Number : 225-654-1061
Fax Number : 225-654-0791
Provider Business Practice Location Address
First Line : 2421 CHURCH ST
Second Line :
City : ZACHARY
State : LA
Zip : 70791-2710
Country : US
Telephone Number : 225-654-1061
Fax Number : 225-654-0791
Authorized Official
Title or Position : OWNER
Name : BARON JAMES WILLIAMSON
Credential : M.D.
Telephone Number : 225-654-1061
Provider Enumeration Date : 03/27/2007
Last Update Date : 08/22/2020

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

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