Provider Demographics
NPI:1205002383
Name:LOUISIANA DISCOUNT OPTICAL INC
Entity Type:Organization
Organization Name:LOUISIANA DISCOUNT OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:MUNN
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:504-427-2478
Mailing Address - Street 1:PO BOX 874
Mailing Address - Street 2:
Mailing Address - City:CHALMETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70044-0874
Mailing Address - Country:US
Mailing Address - Phone:504-281-2242
Mailing Address - Fax:504-281-2243
Practice Address - Street 1:9128 W JUDGE PEREZ DR
Practice Address - Street 2:
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-4527
Practice Address - Country:US
Practice Address - Phone:504-427-2478
Practice Address - Fax:504-281-2243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1962623199Medicaid