Provider Demographics
NPI:1508943374
Name:NATCHITOCHES FAMILY EYE CARE LLC
Entity Type:Organization
Organization Name:NATCHITOCHES FAMILY EYE CARE LLC
Other - Org Name:CENTER FOR SIGHT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PETE
Authorized Official - Middle Name:
Authorized Official - Last Name:WARDELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:318-357-8194
Mailing Address - Street 1:140 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-5725
Mailing Address - Country:US
Mailing Address - Phone:318-357-8194
Mailing Address - Fax:318-352-3145
Practice Address - Street 1:140 E 5TH ST
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-5725
Practice Address - Country:US
Practice Address - Phone:318-357-8194
Practice Address - Fax:318-352-3145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1419543T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5862720001OtherSUPPLIER (DME)
LA1407895Medicaid
LA1407895Medicaid