Provider Demographics
NPI:1497249361
Name:OPTIMAL EYE CARE CENTER, L.L.C.
Entity Type:Organization
Organization Name:OPTIMAL EYE CARE CENTER, L.L.C.
Other - Org Name:OPTIMAL VISION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHONG
Authorized Official - Middle Name:QUOC
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:337-251-6018
Mailing Address - Street 1:809 SUMMER BREEZE DR APT 305
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-6197
Mailing Address - Country:US
Mailing Address - Phone:225-570-2753
Mailing Address - Fax:
Practice Address - Street 1:20103 OLD SCENIC HWY STE 2B
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791
Practice Address - Country:US
Practice Address - Phone:225-570-2753
Practice Address - Fax:225-570-2758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-14
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1629662T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2443381Medicaid