Provider Demographics
NPI:1659551232
Name:ACCENT OPTICAL, INC.
Entity Type:Organization
Organization Name:ACCENT OPTICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EVA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LAMENDOLA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:225-647-4430
Mailing Address - Street 1:1004 W HIGHWAY 30 STE 100
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-5001
Mailing Address - Country:US
Mailing Address - Phone:225-647-4430
Mailing Address - Fax:
Practice Address - Street 1:1004 W HIGHWAY 30 STE 100
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-5001
Practice Address - Country:US
Practice Address - Phone:225-647-4430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-12
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1410546T332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1024830Medicaid
LA1024830Medicaid