Provider Demographics
NPI:1396968640
Name:TONI C HARVEYOD APO LLC
Entity type:Organization
Organization Name:TONI C HARVEYOD APO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TONI
Authorized Official - Middle Name:C
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:318-442-0243
Mailing Address - Street 1:2148 N MALL DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3647
Mailing Address - Country:US
Mailing Address - Phone:318-442-0243
Mailing Address - Fax:318-442-2406
Practice Address - Street 1:2148 N MALL DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3647
Practice Address - Country:US
Practice Address - Phone:318-442-0243
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1071-114T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1442186Medicaid
LA1442186Medicaid
LA4331420001Medicare NSC
LAU24161Medicare UPIN