River Parishes Eyecare | |
10900 Highway 3125 Ste F Lutcher LA 70071-5639 | |
(225) 869-5043 | |
(225) 869-8400 |
Full Name | River Parishes Eyecare |
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Speciality | Clinic/Center |
Location | 10900 Highway 3125, Lutcher, Louisiana |
Authorized Official Name and Position | Richard L. Granger (OWNER) |
Authorized Official Contact | 2258695043 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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River Parishes Eyecare 10900 Highway 3125 Ste F Lutcher LA 70071-5639 Ph: (225) 869-5043 | River Parishes Eyecare 10900 Highway 3125 Ste F Lutcher LA 70071-5639 Ph: (225) 869-5043 |
NPI Number | 1477856771 |
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Provider Enumeration Date | 12/08/2010 |
Last Update Date | 01/13/2011 |
Medicare PECOS PAC ID | 3072631712 |
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Medicare Enrollment ID | O20110113000617 |
Identifier | Type | State | Issuer |
---|---|---|---|
1477856771 | NPI | - | NPPES |
1360163 | Medicaid | LA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | 976-139T (Louisiana) | Primary |
Provider Name | Richard L Granger |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1720058878 PECOS PAC ID: 2163453937 Enrollment ID: I20050823000004 |
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