Provider Demographics
NPI:1346545019
Name:THE LAPLACE OPTOMETRY GROUP
Entity Type:Organization
Organization Name:THE LAPLACE OPTOMETRY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:OSTRICK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:985-652-4097
Mailing Address - Street 1:916 CARROLLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-3304
Mailing Address - Country:US
Mailing Address - Phone:985-652-4097
Mailing Address - Fax:985-652-9917
Practice Address - Street 1:916 CARROLLWOOD DR
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-3304
Practice Address - Country:US
Practice Address - Phone:985-652-4097
Practice Address - Fax:985-652-9917
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVID M. OSTRICK, OD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA850-103T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1397296Medicaid
LA1397296Medicaid