Provider Demographics
NPI:1164642740
Name:RICHARD J PICCIONE MD APMC
Entity Type:Organization
Organization Name:RICHARD J PICCIONE MD APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:PICCIONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-989-2600
Mailing Address - Street 1:4906 AMBASSADOR CAFFERY PKWY
Mailing Address - Street 2:STE. 701
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6916
Mailing Address - Country:US
Mailing Address - Phone:337-989-2600
Mailing Address - Fax:337-989-2601
Practice Address - Street 1:4906 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:STE. 701
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6916
Practice Address - Country:US
Practice Address - Phone:337-989-2600
Practice Address - Fax:337-989-2601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA 1392-523T152W00000X
LAMD.09888R207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LABLUE CROSSOther4398981580
LA1103942Medicaid
LABLUE CROSSOther4398981580