Provider Demographics
NPI:1699883850
Name:CRONAN, REBECCA SUE MUMM (OD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:SUE MUMM
Last Name:CRONAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:SUE
Other - Last Name:MUMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5475 MOULON ROUGE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-5283
Mailing Address - Country:US
Mailing Address - Phone:337-480-1351
Mailing Address - Fax:337-474-8196
Practice Address - Street 1:3451 NELSON RD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-1209
Practice Address - Country:US
Practice Address - Phone:337-474-6850
Practice Address - Fax:337-474-8196
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1329-463T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist