Provider Demographics
NPI:1508876095
Name:GLASSES UNLIMITED, INC.
Entity Type:Organization
Organization Name:GLASSES UNLIMITED, INC.
Other - Org Name:PAYLESS OPTICAL OUTLET
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:MCCLURE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-753-0441
Mailing Address - Street 1:5368 KENNESAW DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-2555
Mailing Address - Country:US
Mailing Address - Phone:225-753-0441
Mailing Address - Fax:225-753-3320
Practice Address - Street 1:3153 E TEXAS ST
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-3209
Practice Address - Country:US
Practice Address - Phone:318-741-0678
Practice Address - Fax:318-741-0679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9181884001332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1156612Medicaid