Provider Demographics
NPI:1497873079
Name:FINK, GEORGE P (OD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:P
Last Name:FINK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 E PRIEN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-8686
Mailing Address - Country:US
Mailing Address - Phone:337-478-5776
Mailing Address - Fax:337-478-0708
Practice Address - Street 1:628 E PRIEN LAKE RD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8686
Practice Address - Country:US
Practice Address - Phone:337-478-5776
Practice Address - Fax:337-478-0708
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA795-162T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1174009Medicaid
LA48084Medicare ID - Type Unspecified
LAT19501Medicare UPIN