Provider Demographics
NPI:1306975420
Name:THE VISION STORE OF LAPLACE, INC.
Entity type:Organization
Organization Name:THE VISION STORE OF LAPLACE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:KURICA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-652-3937
Mailing Address - Street 1:370 BELLE TERRE BLVD
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-2435
Mailing Address - Country:US
Mailing Address - Phone:985-652-3937
Mailing Address - Fax:984-652-3941
Practice Address - Street 1:370 BELLE TERRE BLVD
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-2435
Practice Address - Country:US
Practice Address - Phone:985-652-3937
Practice Address - Fax:984-652-3941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16584332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1366251Medicaid
LA0229140001Medicare NSC