Provider Demographics
NPI:1548211170
Name:EYEWEAR UNLIMITED
Entity Type:Organization
Organization Name:EYEWEAR UNLIMITED
Other - Org Name:ASCENSION OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:F
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:225-647-6549
Mailing Address - Street 1:2308 SOUTH BURNSIDE
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-4664
Mailing Address - Country:US
Mailing Address - Phone:225-647-6549
Mailing Address - Fax:225-647-6734
Practice Address - Street 1:2308 SOUTH BURNSIDE
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-4664
Practice Address - Country:US
Practice Address - Phone:225-647-6549
Practice Address - Fax:225-647-6734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA773206T332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1196819Medicaid
LA0202010001Medicare ID - Type Unspecified
LA1196819Medicaid