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SHENANDOAH EYE CLINIC NPI 1497707780


NPI Information

NPI: 1497707780
Provider Name: SHENANDOAH EYE CLINIC

Former Legal Business Name: THE LENS SOURCE

Classification: Eyewear Supplier - 332H00000X
Entity Type: Organization
Address:
5237 JONES CREEK ROAD
BATON ROUGE, LA
ZIP 70817
Phone: (225) 755-3937
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SHENANDOAH EYE CLINIC is an eyewear supplier in Baton Rouge, LA. The provider is an organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist. SHENANDOAH EYE CLINIC NPI is 1497707780. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Former Legal Business Name Is The Lens Source.

The provider's business location address is:

5237 JONES CREEK ROAD
BATON ROUGE, LA
ZIP 70817-124
Phone: (225) 755-3937
Fax: (225) 755-2272

The provider's authorized official is Edwin F Adams .
The authorized official title is Optometrist/owner/ceo and has the following contact phone number (225) 755-3937.

The enumeration date for this NPI number is 5/16/2006 and was last updated on 7/9/2014.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1152W00000XOptometristNo
2152WC0802XOptometristCorneal and Contact ManagementNo
3152WS0006XOptometristSports VisionNo
4332H00000XEyewear SupplierLA773206TLOUISIANAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1496905304MEDICARE ID-TYPE UNSPECIFIEDLOUISIANA
2P19653MEDICARE UPIN
30699540001OTHERLOUISIANAMEDICARE SUPPLIER #
41196519MEDICAIDLOUISIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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