Provider Demographics
NPI:1497825194
Name:GLASER VISION VENTURES, INC.
Entity Type:Organization
Organization Name:GLASER VISION VENTURES, INC.
Other - Org Name:ST. CHARLES VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:
Authorized Official - Last Name:PITTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-866-7352
Mailing Address - Street 1:13322 HIGHWAY 90
Mailing Address - Street 2:SUITE L
Mailing Address - City:BOUTTE
Mailing Address - State:LA
Mailing Address - Zip Code:70039-3039
Mailing Address - Country:US
Mailing Address - Phone:985-785-8484
Mailing Address - Fax:985-785-8483
Practice Address - Street 1:13322 HIGHWAY 90
Practice Address - Street 2:SUITE L
Practice Address - City:BOUTTE
Practice Address - State:LA
Practice Address - Zip Code:70039-3039
Practice Address - Country:US
Practice Address - Phone:985-785-8484
Practice Address - Fax:985-785-8483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA0698350001Medicare NSC
LA56931Medicare PIN