Provider Demographics
NPI:1962564351
Name:EVANGELINE OPTICAL INC.
Entity type:Organization
Organization Name:EVANGELINE OPTICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFPAUIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-365-4893
Mailing Address - Street 1:306A N LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70563-2843
Mailing Address - Country:US
Mailing Address - Phone:337-365-4893
Mailing Address - Fax:337-365-4894
Practice Address - Street 1:306A N LEWIS ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-2843
Practice Address - Country:US
Practice Address - Phone:337-365-4893
Practice Address - Fax:337-365-4894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1128902Medicaid
LA1128902Medicaid