Provider Demographics
NPI:1760413983
Name:GEOFFROY, LARRY (OD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:GEOFFROY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S MAIN ST
Mailing Address - Street 2:STE E
Mailing Address - City:SAINT MARTINVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70582-4544
Mailing Address - Country:US
Mailing Address - Phone:337-394-5595
Mailing Address - Fax:337-394-5597
Practice Address - Street 1:400 S MAIN ST
Practice Address - Street 2:STE E
Practice Address - City:SAINT MARTINVILLE
Practice Address - State:LA
Practice Address - Zip Code:70582-4544
Practice Address - Country:US
Practice Address - Phone:337-394-5595
Practice Address - Fax:337-394-5597
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA959-228T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1344061Medicaid
LA1344061Medicaid
LA0489800001Medicare NSC
LAT19437Medicare UPIN