Provider Demographics
NPI:1568794782
Name:CRESCENT CITY VISION
Entity Type:Organization
Organization Name:CRESCENT CITY VISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:COUSIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:504-347-9988
Mailing Address - Street 1:5128 LAPALCO BLVD
Mailing Address - Street 2:SUITE H
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-4249
Mailing Address - Country:US
Mailing Address - Phone:504-347-9988
Mailing Address - Fax:504-347-5003
Practice Address - Street 1:5128 LAPALCO BLVD
Practice Address - Street 2:SUITE H
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-4249
Practice Address - Country:US
Practice Address - Phone:504-347-9988
Practice Address - Fax:504-347-5003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-14
Last Update Date:2010-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15422332B00000X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies