Provider Demographics
NPI:1215064423
Name:LOUISIANA STATE OPTICAL OF LAFAYETTE, INC.
Entity type:Organization
Organization Name:LOUISIANA STATE OPTICAL OF LAFAYETTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY-TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:TRICHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-477-3662
Mailing Address - Street 1:826 E ADMIRAL DOYLE DR
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-6747
Mailing Address - Country:US
Mailing Address - Phone:337-367-6553
Mailing Address - Fax:
Practice Address - Street 1:826 E ADMIRAL DOYLE DR
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-6747
Practice Address - Country:US
Practice Address - Phone:337-367-6553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1380369Medicaid
LA1380369Medicaid
LALSOI0307Medicare UPIN