Provider Demographics
NPI:1811124415
Name:MUNN, DAVID W JR (OPTICIAN)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:MUNN
Suffix:JR
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9128 W JUDGE PEREZ DR
Mailing Address - Street 2:
Mailing Address - City:CHALMETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70043-4527
Mailing Address - Country:US
Mailing Address - Phone:504-427-2478
Mailing Address - Fax:
Practice Address - Street 1:1046 PAUL MAILLARD RD
Practice Address - Street 2:
Practice Address - City:LULING
Practice Address - State:LA
Practice Address - Zip Code:70070-0051
Practice Address - Country:US
Practice Address - Phone:504-427-2478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1676306Medicaid
LA1314862Medicaid