Provider Demographics
NPI:1891879821
Name:THE VISUAL DIFFERENCE LLC
Entity Type:Organization
Organization Name:THE VISUAL DIFFERENCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:318-202-5845
Mailing Address - Street 1:303 N TRENTON ST
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-3805
Mailing Address - Country:US
Mailing Address - Phone:318-202-5845
Mailing Address - Fax:318-202-5847
Practice Address - Street 1:303 N TRENTON ST
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-3805
Practice Address - Country:US
Practice Address - Phone:318-202-5845
Practice Address - Fax:318-202-5847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1285-436T152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1431362Medicaid
LA438255775COtherBLUE CROSS
LA438255775COtherBLUE CROSS
LA6312800001Medicare NSC