Provider Demographics
NPI:1821215559
Name:RED RIVER OPTICAL, INC.
Entity Type:Organization
Organization Name:RED RIVER OPTICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:PLANCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-212-7881
Mailing Address - Street 1:2400 HOSPITAL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2385
Mailing Address - Country:US
Mailing Address - Phone:318-212-7881
Mailing Address - Fax:318-212-7865
Practice Address - Street 1:2400 HOSPITAL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2385
Practice Address - Country:US
Practice Address - Phone:318-212-7881
Practice Address - Fax:318-212-7865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1821215559Medicare NSC
1119500001Medicare ID - Type Unspecified