Provider Demographics
NPI:1083927578
Name:BELANGER EYE CARE,LLC
Entity Type:Organization
Organization Name:BELANGER EYE CARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:BELANGER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:225-654-1176
Mailing Address - Street 1:1217 MILLS POINTE DR
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-6227
Mailing Address - Country:US
Mailing Address - Phone:225-654-1176
Mailing Address - Fax:225-654-3047
Practice Address - Street 1:5801 MAIN ST
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-4028
Practice Address - Country:US
Practice Address - Phone:225-328-2499
Practice Address - Fax:225-654-3047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-26
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1390-521T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1475963Medicaid
LA1475963Medicaid