Provider Demographics
NPI:1356364046
Name:ROY, JOSEPH E (OD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:E
Last Name:ROY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DERIDDER
Mailing Address - State:LA
Mailing Address - Zip Code:70634-4057
Mailing Address - Country:US
Mailing Address - Phone:337-463-2020
Mailing Address - Fax:337-463-7108
Practice Address - Street 1:123 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634-4057
Practice Address - Country:US
Practice Address - Phone:337-463-2020
Practice Address - Fax:337-463-7108
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA782-068T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1159361Medicaid
LAT19514Medicare UPIN
LA1159361Medicaid