Provider Demographics
NPI:1568460533
Name:VINCENT, CARY J (OD)
Entity Type:Individual
Prefix:
First Name:CARY
Middle Name:J
Last Name:VINCENT
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 1:608 TERRY PKWY
Mailing Address - Street 2:
Mailing Address - City:TERRYTOWN
Mailing Address - State:LA
Mailing Address - Zip Code:70056-4306
Mailing Address - Country:US
Mailing Address - Phone:504-361-3937
Mailing Address - Fax:504-364-5700
Practice Address - Street 1:608 TERRY PKWY
Practice Address - Street 2:
Practice Address - City:TERRYTOWN
Practice Address - State:LA
Practice Address - Zip Code:70056-4306
Practice Address - Country:US
Practice Address - Phone:504-361-3937
Practice Address - Fax:504-364-5700
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA835-020T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1336653Medicaid
48895C533Medicare ID - Type Unspecified
T19603Medicare UPIN