Provider Demographics
NPI:1801229125
Name:MCNEASE, MEGHAN L (OD, LLC)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:L
Last Name:MCNEASE
Suffix:
Gender:F
Credentials:OD, LLC
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:L
Other - Last Name:MCNEASE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD, LLC
Mailing Address - Street 1:4255 BULL CHUTE RD
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:71264-9152
Mailing Address - Country:US
Mailing Address - Phone:318-614-4880
Mailing Address - Fax:318-281-1635
Practice Address - Street 1:6091 MER ROUGE RD.
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220
Practice Address - Country:US
Practice Address - Phone:318-281-1664
Practice Address - Fax:318-281-1635
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-11
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1667-701T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2343360Medicaid