Provider Demographics
NPI:1891340899
Name:JOSEPH E HUMBLE AND RAYMOND HAIK, PTRS
Entity Type:Organization
Organization Name:JOSEPH E HUMBLE AND RAYMOND HAIK, PTRS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ELGIN
Authorized Official - Last Name:HUMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-325-2610
Mailing Address - Street 1:1804 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-4414
Mailing Address - Country:US
Mailing Address - Phone:318-325-2610
Mailing Address - Fax:318-325-7715
Practice Address - Street 1:1801 AUBURN AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5005
Practice Address - Country:US
Practice Address - Phone:318-812-1600
Practice Address - Fax:318-812-2500
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOSEPH E HUMBLE AND RAYMOND HAIK, PTRS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA0407850001OtherDME SUPPLIER #