1457435612 NPI number — VISION OPTIQUE INC

Table of content: (NPI 1457435612)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457435612 NPI number — VISION OPTIQUE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VISION OPTIQUE INC
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:
VISION OPTIQUE C21
Provider Other Organization Name Type Code:
5
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:
1457435612
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1950
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANDEVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70470-1950
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-727-9948
Provider Business Mailing Address Fax Number:
985-237-6008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
70380 HIGHWAY 21
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COVINGTON
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70433-8128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-635-6996
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/24/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GRUENIG
Authorized Official First Name:
RODERICK
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
985-727-9948

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 156FX1800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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