Provider Demographics
NPI:1427356062
Name:GRAND VISION LAFRENIERE, L.L.C.
Entity type:Organization
Organization Name:GRAND VISION LAFRENIERE, L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSSELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:504-322-7525
Mailing Address - Street 1:6601 VETERANS MEMORIAL BLVD
Mailing Address - Street 2:STE 19 - 21
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70003-3943
Mailing Address - Country:US
Mailing Address - Phone:504-322-7525
Mailing Address - Fax:504-322-7529
Practice Address - Street 1:6601 VETERANS MEMORIAL BLVD
Practice Address - Street 2:STE 19 - 21
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70003-3943
Practice Address - Country:US
Practice Address - Phone:504-322-7525
Practice Address - Fax:504-322-7529
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRAND VISION, L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-07
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA869112T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1950815Medicaid
LA1950815Medicaid