Provider Demographics
NPI:1386715985
Name:THE HAMMOND EYE CLINIC, L.L.C.
Entity type:Organization
Organization Name:THE HAMMOND EYE CLINIC, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:PRADILLO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:985-345-0607
Mailing Address - Street 1:110 W ROBERT ST
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401-3227
Mailing Address - Country:US
Mailing Address - Phone:985-345-0607
Mailing Address - Fax:985-345-0490
Practice Address - Street 1:110 W ROBERT ST
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401-3227
Practice Address - Country:US
Practice Address - Phone:985-345-0607
Practice Address - Fax:985-345-0490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1534-565T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1949949Medicaid
LA3930250001Medicare NSC
LA5C619Medicare ID - Type Unspecified