Provider Demographics
NPI:1740493089
Name:EYE SPECIALSITS EYEWEAR,LLC
Entity type:Organization
Organization Name:EYE SPECIALSITS EYEWEAR,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:T
Authorized Official - Last Name:VIATOR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:225-768-7777
Mailing Address - Street 1:7777 HENNESSY BLVD
Mailing Address - Street 2:SUITE 5000
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4300
Mailing Address - Country:US
Mailing Address - Phone:225-768-7777
Mailing Address - Fax:225-214-3400
Practice Address - Street 1:7777 HENNESSY BLVD
Practice Address - Street 2:SUITE 5000
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4300
Practice Address - Country:US
Practice Address - Phone:225-768-7777
Practice Address - Fax:225-214-3400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA22377156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA0371150002Medicare ID - Type UnspecifiedOPTICAL SHOP