Provider Demographics
NPI:1811033376
Name:CASANOVA, JOHN M
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:M
Last Name:CASANOVA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1022
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70527-1022
Mailing Address - Country:US
Mailing Address - Phone:337-783-3073
Mailing Address - Fax:337-783-2548
Practice Address - Street 1:515 E 6TH ST
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-4503
Practice Address - Country:US
Practice Address - Phone:337-783-3073
Practice Address - Fax:337-783-2548
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1015237700000X
156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician