Provider Demographics
NPI:1972821650
Name:OPTICAL ZONE LLC
Entity Type:Organization
Organization Name:OPTICAL ZONE LLC
Other - Org Name:EYEMAGINE OPTICAL LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHELBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-524-2226
Mailing Address - Street 1:7607 YOUREE DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5501
Mailing Address - Country:US
Mailing Address - Phone:318-524-2226
Mailing Address - Fax:318-524-2228
Practice Address - Street 1:7607 YOUREE DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5501
Practice Address - Country:US
Practice Address - Phone:318-524-2226
Practice Address - Fax:318-524-2228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-05
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1041998Medicaid
LA1578819Medicaid
LA4F257CS65Medicare PIN
LAH87909Medicare UPIN
LA5K639B787Medicare PIN
LAI34530Medicare UPIN
LAB89834Medicare UPIN
LA1041998Medicaid
LA5J481B787Medicare PIN