Provider Demographics
NPI:1326015751
Name:PRIMO, EARL JOSEPH (O D)
Entity Type:Individual
Prefix:DR
First Name:EARL
Middle Name:JOSEPH
Last Name:PRIMO
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:205 STONEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-5819
Mailing Address - Country:US
Mailing Address - Phone:504-606-1701
Mailing Address - Fax:985-871-9953
Practice Address - Street 1:880 N HIGHWAY 190
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-5147
Practice Address - Country:US
Practice Address - Phone:985-867-8708
Practice Address - Fax:985-867-8711
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1332-466T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1153796Medicaid
LAU93601Medicare UPIN
LA4B277Medicare ID - Type Unspecified