Provider Demographics
NPI:1245364116
Name:KIDD AND ASSOCICATES LLC
Entity type:Organization
Organization Name:KIDD AND ASSOCICATES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:NEWTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-828-3651
Mailing Address - Street 1:1301 VICTOR II BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70380-1305
Mailing Address - Country:US
Mailing Address - Phone:985-385-5744
Mailing Address - Fax:
Practice Address - Street 1:1301 VICTOR II BLVD STE B
Practice Address - Street 2:
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-1305
Practice Address - Country:US
Practice Address - Phone:985-385-5744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KIDD AND ASSOCICATES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-15
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1940283Medicaid
LA434689892AOtherIII BLUE CROSS MC
LA439064365COtherCOMEAUX BC MC
LA1940283Medicaid