Provider Demographics
NPI:1427294230
Name:THE OPTICAL CENTER LLC
Entity type:Organization
Organization Name:THE OPTICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MAURO
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-899-2263
Mailing Address - Street 1:2820 NAPOLEON AVE
Mailing Address - Street 2:SUITE 750
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-6969
Mailing Address - Country:US
Mailing Address - Phone:504-899-2263
Mailing Address - Fax:504-899-2866
Practice Address - Street 1:2820 NAPOLEON AVE
Practice Address - Street 2:SUITE 750
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-6969
Practice Address - Country:US
Practice Address - Phone:504-899-2263
Practice Address - Fax:504-899-2866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA22048332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA00002OtherBLUE CROSS/BLUE SHIELD
LA00003OtherHUMANA
MA00004OtherCIGNA
00001Medicare PIN