Provider Demographics
NPI:1952474942
Name:EYE CARE, INC
Entity Type:Organization
Organization Name:EYE CARE, INC
Other - Org Name:EYE CARE OPTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:M
Authorized Official - Last Name:COULLARD
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:225-654-3131
Mailing Address - Street 1:PO BOX 602
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-0602
Mailing Address - Country:US
Mailing Address - Phone:225-654-3131
Mailing Address - Fax:225-654-0791
Practice Address - Street 1:2421 CHURCH ST
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-2710
Practice Address - Country:US
Practice Address - Phone:225-654-3131
Practice Address - Fax:225-654-0791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1435988Medicaid
LA1435988Medicaid