Provider Demographics
NPI:1316219025
Name:LAPLACE OPTICAL GROUP LLC
Entity type:Organization
Organization Name:LAPLACE OPTICAL GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:V
Authorized Official - Last Name:MILLET
Authorized Official - Suffix:JR
Authorized Official - Credentials:NONE
Authorized Official - Phone:985-652-3300
Mailing Address - Street 1:1036 W AIRLINE HWY STE 119
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-3736
Mailing Address - Country:US
Mailing Address - Phone:985-652-3300
Mailing Address - Fax:
Practice Address - Street 1:1036 W AIRLINE HWY STE 119
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-3736
Practice Address - Country:US
Practice Address - Phone:985-652-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier