Provider Demographics
NPI:1639258726
Name:EYE CARE & COSMETIC CENTER, LLC
Entity Type:Organization
Organization Name:EYE CARE & COSMETIC CENTER, LLC
Other - Org Name:WILLIAMSON ALLEMOND REGIONAL EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING / CODING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHOBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-654-1061
Mailing Address - Street 1:2421 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-2710
Mailing Address - Country:US
Mailing Address - Phone:225-654-1061
Mailing Address - Fax:
Practice Address - Street 1:2421 CHURCH ST
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-2710
Practice Address - Country:US
Practice Address - Phone:225-654-1061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1459518Medicaid
LA5CW27Medicare PIN
LA1459518Medicaid