MEDICARE: LARRY GEOFFROY O.D.

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	959-228T	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

General Provider Information

NPI Number	:	1760413983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY GEOFFROY O.D.

Provider Business Mailing Address
First Line	:	400 S MAIN ST
Second Line	:	STE E
City	:	SAINT MARTINVILLE
State	:	LA
Zip	:	70582-4544
Country	:	US
Telephone Number	:	337-394-5595
Fax Number	:	337-394-5597

Provider Business Practice Location Address
First Line	:	400 S MAIN ST
Second Line	:	STE E
City	:	SAINT MARTINVILLE
State	:	LA
Zip	:	70582-4544
Country	:	US
Telephone Number	:	337-394-5595
Fax Number	:	337-394-5597

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

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	01/27/2009

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