Provider Demographics
NPI:1245428275
Name:BOSSIER FAMILY EYE CARE, INC.
Entity Type:Organization
Organization Name:BOSSIER FAMILY EYE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:PASTILONG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:318-747-0302
Mailing Address - Street 1:1519 DOCTORS DR STE 1
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-3676
Mailing Address - Country:US
Mailing Address - Phone:318-747-0302
Mailing Address - Fax:318-747-2742
Practice Address - Street 1:1519 DOCTORS DR STE 1
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-3676
Practice Address - Country:US
Practice Address - Phone:318-747-0302
Practice Address - Fax:318-747-2742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1197 365T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
19798032200OtherHUMANA GOLD PLUS
8002824OtherCIGNA
LA1538833Medicaid
LA2369878820OtherBLUE CROSS
8002824OtherCIGNA
LA5CJ72Medicare UPIN