Provider Demographics
NPI:1538451281
Name:UNIQUE FAMILY OPTICAL
Entity type:Organization
Organization Name:UNIQUE FAMILY OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBEAUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-393-2554
Mailing Address - Street 1:4480 GENERAL DEGAULLE DR
Mailing Address - Street 2:SUITE 112
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131
Mailing Address - Country:US
Mailing Address - Phone:504-393-2554
Mailing Address - Fax:504-393-2536
Practice Address - Street 1:4480 GENERAL DEGAULLE DR
Practice Address - Street 2:SUITE 112
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70131-6941
Practice Address - Country:US
Practice Address - Phone:504-393-2554
Practice Address - Fax:504-393-2536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier