Provider Demographics
NPI:1841421815
Name:CALHOUN, LANNIE MICHAEL (OD)
Entity type:Individual
Prefix:DR
First Name:LANNIE
Middle Name:MICHAEL
Last Name:CALHOUN
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 1:6739 CHAPARRAL PL
Mailing Address - Street 2:
Mailing Address - City:GREENWELL SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70739-3101
Mailing Address - Country:US
Mailing Address - Phone:225-775-9406
Mailing Address - Fax:225-775-0258
Practice Address - Street 1:13131 PLANK RD
Practice Address - Street 2:
Practice Address - City:BAKER
Practice Address - State:LA
Practice Address - Zip Code:70714-4914
Practice Address - Country:US
Practice Address - Phone:225-775-9406
Practice Address - Fax:225-775-0258
Is Sole Proprietor?:No
Enumeration Date:2009-08-07
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7394T152W00000X
LA1774-708T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2387201Medicaid