Provider Demographics
NPI:1720058878
Name:GRANGER, RICHARD L (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:GRANGER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:RIVER
Other - Middle Name:PARISHES
Other - Last Name:EYECARE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10900 HIGHWAY 3125
Mailing Address - Street 2:SUITE F
Mailing Address - City:LUTCHER
Mailing Address - State:LA
Mailing Address - Zip Code:70071-5639
Mailing Address - Country:US
Mailing Address - Phone:225-869-5043
Mailing Address - Fax:225-869-8400
Practice Address - Street 1:10900 HIGHWAY 3125
Practice Address - Street 2:SUITE F
Practice Address - City:LUTCHER
Practice Address - State:LA
Practice Address - Zip Code:70071-5639
Practice Address - Country:US
Practice Address - Phone:225-869-5043
Practice Address - Fax:225-869-8400
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA. 976-139T152W00000X
LA976-139T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1360163Medicaid
LA1360163Medicaid
LA0357680001Medicare NSC
LA47844Medicare ID - Type Unspecified