Provider Demographics
NPI:1225301203
Name:OPTICAL ZONE, LLC
Entity Type:Organization
Organization Name:OPTICAL ZONE, LLC
Other - Org Name:EYEMAGINE OPTICAL, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:SWEARINGEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:318-629-1870
Mailing Address - Street 1:2530 BERT KOUNS INDUSTRIAL LOOP
Mailing Address - Street 2:SUITE 116
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3132
Mailing Address - Country:US
Mailing Address - Phone:318-629-1870
Mailing Address - Fax:318-629-1874
Practice Address - Street 1:2530 BERT KOUNS INDUSTRIAL LOOP
Practice Address - Street 2:SUITE 116
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3132
Practice Address - Country:US
Practice Address - Phone:318-629-1870
Practice Address - Fax:318-629-1874
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPTICAL ZONE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier