1366575615 NPI number — KIDD AND ASSOCICATES LLC

Table of content: (NPI 1366575615)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366575615 NPI number — KIDD AND ASSOCICATES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIDD AND ASSOCICATES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KIDD VISION CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366575615
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 NORTHWEST BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70538
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-828-3651
Provider Business Mailing Address Fax Number:
337-828-0586

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 NORTHWEST BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70538-3442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-828-3651
Provider Business Practice Location Address Fax Number:
337-828-0586
Provider Enumeration Date:
03/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CHAUVIN
Authorized Official First Name:
KRISSA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER/BILLER
Authorized Official Telephone Number:
337-828-3651

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  753-087T , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1170534 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: T19440 . This is a "UPIN" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 439064365B . This is a "COMEAUX BC FKLN" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 19040283 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 434689892B . This is a "III BLUE CROSS FKLN" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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