Provider Demographics
NPI:1336370618
Name:CENTRAL EYE CARE COSMETIC CENTER AND OPTICAL, LLC
Entity Type:Organization
Organization Name:CENTRAL EYE CARE COSMETIC CENTER AND OPTICAL, LLC
Other - Org Name:ROGERS REGIONAL EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:225-261-6282
Mailing Address - Street 1:18522 MAGNOLIA BRIDGE RD STE A
Mailing Address - Street 2:
Mailing Address - City:GREENWELL SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70739-4628
Mailing Address - Country:US
Mailing Address - Phone:225-261-6282
Mailing Address - Fax:225-261-6012
Practice Address - Street 1:18522 MAGNOLIA BRIDGE RD STE A
Practice Address - Street 2:
Practice Address - City:GREENWELL SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70739-4628
Practice Address - Country:US
Practice Address - Phone:225-261-6282
Practice Address - Fax:225-261-6012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-04
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1560-592T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1459518Medicaid
LA1459518Medicaid