MEDICARE: JOSEPH V SICA SR A PROFESSIONAL OPTOMETRIC CORP

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	631-088T	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	:	1942527940
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSEPH V SICA SR A PROFESSIONAL OPTOMETRIC CORP

Provider Business Mailing Address
First Line	:	312 S JEFFERSON AVE
Second Line	:
City	:	COVINGTON
State	:	LA
Zip	:	70433-3169
Country	:	US
Telephone Number	:	985-892-2722
Fax Number	:	985-892-3418

Provider Business Practice Location Address
First Line	:	312 S JEFFERSON AVE
Second Line	:
City	:	COVINGTON
State	:	LA
Zip	:	70433-3169
Country	:	US
Telephone Number	:	985-892-2722
Fax Number	:	985-892-3418

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. JOSEPH VINCENT SICA
Credential	:	O.D.
Telephone Number	:	985-892-2722

Provider Enumeration Date	:	04/29/2010
Last Update Date	:	01/12/2011

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