MEDICARE: DR. VICTOR C LACOUR OD

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	S552	AL

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	3551058483	OTHER		BC BS

General Provider Information

NPI Number	:	1649346446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VICTOR C LACOUR OD

Provider Business Mailing Address
First Line	:	7459 KEITH DR
Second Line	:
City	:	MCCALLA
State	:	AL
Zip	:	35111
Country	:	US
Telephone Number	:	205-477-5200
Fax Number	:

Provider Business Practice Location Address
First Line	:	7459 KEITH DR
Second Line	:
City	:	MC CALLA
State	:	AL
Zip	:	35111-3337
Country	:	US
Telephone Number	:	205-902-9051
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	11/08/2018

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