MEDICARE: LOUISIANA EYE CARE

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	928-208T	LA
2	152W00000X	Optometrist

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

General Provider Information

NPI Number	:	1730363052
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOUISIANA EYE CARE

Provider Business Mailing Address
First Line	:	1330 S RANGE AVE
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-4810
Country	:	US
Telephone Number	:	225-664-2189
Fax Number	:

Provider Business Practice Location Address
First Line	:	1330 S RANGE AVE
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-4810
Country	:	US
Telephone Number	:	225-664-2189
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	JENNIFER BECK
Credential	:
Telephone Number	:	225-664-2189

Provider Enumeration Date	:	12/21/2007
Last Update Date	:	03/23/2021

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Directions to “LOUISIANA EYE CARE ” Practice Location

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