Provider Demographics
NPI:1295834141
Name:LACOMBE, RICKY (OD)
Entity Type:Individual
Prefix:DR
First Name:RICKY
Middle Name:
Last Name:LACOMBE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 AMBASSADOR CAFFERY PKWY STE D
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6760
Mailing Address - Country:US
Mailing Address - Phone:337-984-3234
Mailing Address - Fax:337-989-2611
Practice Address - Street 1:4400 AMBASSADOR CAFFERY PKWY STE D
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6760
Practice Address - Country:US
Practice Address - Phone:337-984-3234
Practice Address - Fax:337-989-2611
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA913-243T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAU19604Medicare UPIN
49221Medicare ID - Type Unspecified