1821223231 NPI number — OLIVER WENDALL WHITNEY A PROFESSIONAL OPTOMETRY CORP (APOC)

Table of content: (NPI 1821223231)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821223231 NPI number — OLIVER WENDALL WHITNEY A PROFESSIONAL OPTOMETRY CORP (APOC)

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OLIVER WENDALL WHITNEY A PROFESSIONAL OPTOMETRY CORP (APOC)
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821223231
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 879
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANDEVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70470-0879
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-626-5242
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1580 W CAUSEWAY APPROACH
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
MANDEVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70471-3033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-626-5242
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/29/2009

Additional Information

Authorized Official

Authorized Official Last Name:
WHITNEY
Authorized Official First Name:
OLIVER
Authorized Official Middle Name:
WENDELL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
985-626-5242

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  810300 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1176923 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com