Provider Demographics
NPI:1023685435
Name:EYECONIC VIEW EYECARE LLC
Entity type:Organization
Organization Name:EYECONIC VIEW EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHONDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:615-828-3904
Mailing Address - Street 1:2880 CRESTHAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-0464
Mailing Address - Country:US
Mailing Address - Phone:615-828-3904
Mailing Address - Fax:
Practice Address - Street 1:2001 MILLERVILLE RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-1408
Practice Address - Country:US
Practice Address - Phone:225-293-7141
Practice Address - Fax:225-293-2840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-06
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1816761Medicaid
1790847218OtherNPI- DR. LEWIS