Provider Demographics
NPI:1326244880
Name:PARADISE OPTICAL & GIFTS
Entity Type:Organization
Organization Name:PARADISE OPTICAL & GIFTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:FALGOUST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-477-0963
Mailing Address - Street 1:PO BOX 4765
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70606-4765
Mailing Address - Country:US
Mailing Address - Phone:337-477-0963
Mailing Address - Fax:337-477-1912
Practice Address - Street 1:1980 TYBEE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-4173
Practice Address - Country:US
Practice Address - Phone:337-477-0963
Practice Address - Fax:337-477-1912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD1217R332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4594720001Medicare NSC