Provider Demographics
NPI:1184942401
Name:ACHORD EYE CLINIC LLC
Entity type:Organization
Organization Name:ACHORD EYE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:SHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ACHORD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:225-767-3937
Mailing Address - Street 1:12726 PERKINS RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-1910
Mailing Address - Country:US
Mailing Address - Phone:225-767-3937
Mailing Address - Fax:225-767-3917
Practice Address - Street 1:12726 PERKINS ROAD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-1910
Practice Address - Country:US
Practice Address - Phone:225-767-3937
Practice Address - Fax:225-767-3917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-11
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1095-205T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2322613Medicaid
LA2322613Medicaid
U34752Medicare UPIN