1376985507 NPI number — DR. HANNAH EASTMAN FAWCETT O.D.

Table of content: DR. HANNAH EASTMAN FAWCETT O.D. (NPI 1376985507)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376985507 NPI number — DR. HANNAH EASTMAN FAWCETT O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EASTMAN FAWCETT
Provider First Name:
HANNAH
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EASTMAN
Provider Other First Name:
HANNAH
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1376985507
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/27/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22141 ELTON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JENNINGS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70546-8542
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-329-2468
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
339 W PRIEN LAKE RD
Provider Second Line Business Practice Location Address:
SUITE 200B
Provider Business Practice Location Address City Name:
LAKE CHARLES
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70601-8452
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-366-0905
Provider Business Practice Location Address Fax Number:
337-474-1409
Provider Enumeration Date:
07/30/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1649-683T , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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