Provider Demographics
NPI:1881679934
Name:SCV VISION OUTLET INC
Entity Type:Organization
Organization Name:SCV VISION OUTLET INC
Other - Org Name:ST CHARLES VISION OUTLET CHATEAU
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:DUPLESSIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-247-9116
Mailing Address - Street 1:817 W ESPLANADE AVE
Mailing Address - Street 2:STE C
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-6219
Mailing Address - Country:US
Mailing Address - Phone:504-712-3551
Mailing Address - Fax:504-712-3556
Practice Address - Street 1:817 W ESPLANADE AVE
Practice Address - Street 2:STE C
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-6287
Practice Address - Country:US
Practice Address - Phone:504-712-3551
Practice Address - Fax:504-712-3556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5DG52Medicare PIN
LA0620160001Medicare NSC