Provider Demographics
NPI:1952327801
Name:MUSSELMAN, JOHN F (OD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:MUSSELMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6601 VETERANS MEMORIAL BLVD
Mailing Address - Street 2:GRAND VISION, SUITE 20
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70003-3943
Mailing Address - Country:US
Mailing Address - Phone:504-322-7525
Mailing Address - Fax:504-866-6928
Practice Address - Street 1:6601 VETERANS MEMORIAL BLVD
Practice Address - Street 2:GRAND VISION, SUITE 20
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70003-3943
Practice Address - Country:US
Practice Address - Phone:504-322-7525
Practice Address - Fax:504-866-6928
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA869-112T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1950815Medicaid
LA48207Medicare ID - Type Unspecified
LA1950815Medicaid