Provider Demographics
NPI:1649346446
Name:LACOUR, VICTOR C (OD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:C
Last Name:LACOUR
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 1:7459 KEITH DR
Mailing Address - Street 2:
Mailing Address - City:MCCALLA
Mailing Address - State:AL
Mailing Address - Zip Code:35111
Mailing Address - Country:US
Mailing Address - Phone:205-477-5200
Mailing Address - Fax:
Practice Address - Street 1:7459 KEITH DR
Practice Address - Street 2:
Practice Address - City:MC CALLA
Practice Address - State:AL
Practice Address - Zip Code:35111-3337
Practice Address - Country:US
Practice Address - Phone:205-902-9051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS552152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000058483Medicaid
3551058483OtherBC BS