Provider Demographics
NPI:1942527940
Name:JOSEPH V SICA SR A PROFESSIONAL OPTOMETRIC CORP
Entity Type:Organization
Organization Name:JOSEPH V SICA SR A PROFESSIONAL OPTOMETRIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:SICA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:985-892-2722
Mailing Address - Street 1:312 S JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-3169
Mailing Address - Country:US
Mailing Address - Phone:985-892-2722
Mailing Address - Fax:985-892-3418
Practice Address - Street 1:312 S JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-3169
Practice Address - Country:US
Practice Address - Phone:985-892-2722
Practice Address - Fax:985-892-3418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-29
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA631-088T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1040631Medicaid
LA1040631Medicaid
LAT19625Medicare UPIN