Provider Demographics
NPI:1639458573
Name:EXTENDED EYECARE SERVICES, LLC
Entity Type:Organization
Organization Name:EXTENDED EYECARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:ZIEGLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:337-781-3709
Mailing Address - Street 1:101 STRATFORD DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-5062
Mailing Address - Country:US
Mailing Address - Phone:337-781-3709
Mailing Address - Fax:337-534-8252
Practice Address - Street 1:101 STRATFORD DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-5062
Practice Address - Country:US
Practice Address - Phone:337-781-3709
Practice Address - Fax:337-534-8252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1283443T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty