Provider Demographics
NPI:1376843722
Name:GREGORY EYE ASSOCIATES INC.
Entity Type:Organization
Organization Name:GREGORY EYE ASSOCIATES INC.
Other - Org Name:GREGORY EYE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHESLEY
Authorized Official - Middle Name:LELWYNN
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:318-256-2020
Mailing Address - Street 1:395 S CAPITOL ST
Mailing Address - Street 2:
Mailing Address - City:MANY
Mailing Address - State:LA
Mailing Address - Zip Code:71449-3049
Mailing Address - Country:US
Mailing Address - Phone:318-256-2020
Mailing Address - Fax:318-256-9568
Practice Address - Street 1:395 S CAPITOL ST
Practice Address - Street 2:
Practice Address - City:MANY
Practice Address - State:LA
Practice Address - Zip Code:71449-3049
Practice Address - Country:US
Practice Address - Phone:318-256-2020
Practice Address - Fax:318-256-9568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-01
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA765-002T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1150631Medicaid
LA5DQ55Medicare PIN
LA1150631Medicaid