MEDICARE: EYES & EYEWEAR INC.

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	809097T	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
2	439724581C	OTHER	LA	BLUE CROSS OF LOUISIANA
3	4358428080	OTHER	LA	BLUE CROSS OF LOUISIANA

General Provider Information

NPI Number	:	1487826996
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYES & EYEWEAR INC.

Provider Business Mailing Address
First Line	:	6823 PINES RD
Second Line	:	SUITE B
City	:	SHREVEPORT
State	:	LA
Zip	:	71129-5205
Country	:	US
Telephone Number	:	318-688-3050
Fax Number	:	318-688-3233

Provider Business Practice Location Address
First Line	:	6823 PINES RD
Second Line	:	SUITE B
City	:	SHREVEPORT
State	:	LA
Zip	:	71129-5205
Country	:	US
Telephone Number	:	318-688-3050
Fax Number	:	318-688-3233

Authorized Official
Title or Position	:	OWNER
Name	:	DONALD WALKER
Credential	:	O.D.
Telephone Number	:	318-688-3050

Provider Enumeration Date	:	03/25/2008
Last Update Date	:	05/31/2012

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Directions to “EYES & EYEWEAR INC. ” Practice Location

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