Provider Demographics
NPI:1528271822
Name:CASANOVA EYE CARE, APMC
Entity type:Organization
Organization Name:CASANOVA EYE CARE, APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:T
Authorized Official - Last Name:CASANOVA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:337-942-3449
Mailing Address - Street 1:1110 DOCTOR AC TERRENCE BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-6403
Mailing Address - Country:US
Mailing Address - Phone:337-942-3449
Mailing Address - Fax:337-942-6019
Practice Address - Street 1:1110 DOCTOR AC TERRENCE BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6403
Practice Address - Country:US
Practice Address - Phone:337-942-3449
Practice Address - Fax:337-942-6019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA020117207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1398888Medicaid
LA1137730001Medicare NSC
LA1398888Medicaid
LAE49744Medicare UPIN