| |
1010 Johnson St, Tallulah, LA 71282-5216 | |
(318) 574-2369 | |
(318) 574-1111 |
Full Name | |
---|---|
Type | Facility |
Speciality | Optometrist |
Location | 1010 Johnson St, Tallulah, Louisiana |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1902970973 | NPI | - | NPPES |
1317446 | Medicaid | LA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 855-135 T (Louisiana) | Primary |
Mailing Address | Practice Location Address |
---|---|
1010 Johnson St, Tallulah, LA 71282-5216 Ph: (318) 574-2369 | 1010 Johnson St, Tallulah, LA 71282-5216 Ph: (318) 574-2369 |