Provider Demographics
NPI:1619957347
Name:VISUAL CARE & CONTACT LENS CLINIC INC
Entity Type:Organization
Organization Name:VISUAL CARE & CONTACT LENS CLINIC INC
Other - Org Name:LEBLANC EYE CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CORNEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:LEBLANC
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:318-445-5292
Mailing Address - Street 1:5917 JACKSON STREET
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303
Mailing Address - Country:US
Mailing Address - Phone:318-445-5292
Mailing Address - Fax:318-448-9627
Practice Address - Street 1:5917 JACKSON STREET
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303
Practice Address - Country:US
Practice Address - Phone:318-445-5292
Practice Address - Fax:318-448-9627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA798123T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA798123TOtherLICENSE
LAML1340102OtherDEA
T19521Medicare UPIN
LA798123TOtherLICENSE