Provider Demographics
NPI:1932960192
Name:DERIDDER OPTICAL LLC
Entity type:Organization
Organization Name:DERIDDER OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:INEZ
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-463-9821
Mailing Address - Street 1:1509 N PINE ST STE A
Mailing Address - Street 2:
Mailing Address - City:DERIDDER
Mailing Address - State:LA
Mailing Address - Zip Code:70634-2417
Mailing Address - Country:US
Mailing Address - Phone:337-463-9821
Mailing Address - Fax:337-463-9821
Practice Address - Street 1:1509 N PINE ST STE A
Practice Address - Street 2:
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634-2417
Practice Address - Country:US
Practice Address - Phone:337-463-9821
Practice Address - Fax:337-463-9821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies