Provider Demographics
NPI:1154643823
Name:CITY OPTICAL
Entity Type:Organization
Organization Name:CITY OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LIONEL
Authorized Official - Middle Name:LORIO
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-291-5533
Mailing Address - Street 1:4460 BLUEBONNET BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-9658
Mailing Address - Country:US
Mailing Address - Phone:225-291-5533
Mailing Address - Fax:225-291-5444
Practice Address - Street 1:4460 BLUEBONNET BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-9658
Practice Address - Country:US
Practice Address - Phone:225-291-5533
Practice Address - Fax:225-291-5444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10-00813-405332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier