Provider Demographics
NPI:1750587622
Name:DON ADDIE CADDO OPTICAL
Entity type:Organization
Organization Name:DON ADDIE CADDO OPTICAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:ADDIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-375-5945
Mailing Address - Street 1:101 E LOUISIANA AVE
Mailing Address - Street 2:
Mailing Address - City:VIVIAN
Mailing Address - State:LA
Mailing Address - Zip Code:71082-2923
Mailing Address - Country:US
Mailing Address - Phone:318-375-5945
Mailing Address - Fax:318-375-5945
Practice Address - Street 1:101 E LOUISIANA AVE
Practice Address - Street 2:
Practice Address - City:VIVIAN
Practice Address - State:LA
Practice Address - Zip Code:71082-2923
Practice Address - Country:US
Practice Address - Phone:318-375-5945
Practice Address - Fax:318-375-5945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1684295Medicaid
LA6025690001Medicare NSC