Provider Demographics
NPI:1275670606
Name:DUNCAN OPTICAL DISPENSARY INC
Entity Type:Organization
Organization Name:DUNCAN OPTICAL DISPENSARY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:C
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-869-3488
Mailing Address - Street 1:4843 LINE AVENUE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-1529
Mailing Address - Country:US
Mailing Address - Phone:318-869-3488
Mailing Address - Fax:318-869-3430
Practice Address - Street 1:4843 LINE AVENUE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-1529
Practice Address - Country:US
Practice Address - Phone:318-869-3488
Practice Address - Fax:318-869-3430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
0511430001Medicare ID - Type Unspecified