Advanced Eyecare, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

1611-644T Issued in LA

Legal business name

ADVANCED EYECARE, LLC

Doing business as

Granger Eye Studio

Practice address

107 Centre Sarcelle Blvd.
Suite 704
Youngsville, LA 70592

Phone

(337) 451-4511

Fax

(337) 857-6044

NPI assigned

Sep 13, 2013

Last updated

Dec 16, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Gary J Granger, ODNPI 1922386564

Title

Optometrist, Ceo

Phone

(337) 451-4511

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Granger Eye Studio Doing business as

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gary J. Granger, O.D.

  • Optometrist
  • Youngsville, LA
  • NPI 1922386564
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1379030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418688000000",
    "number": "1043645666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 CENTRE SARCELLE BLVD.",
            "address_2": "SUITE 704",
            "city": "YOUNGSVILLE",
            "state": "LA",
            "postal_code": "70592",
            "telephone_number": "337-451-4511",
            "fax_number": "337-857-6044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 CENTRE SARCELLE BLVD.",
            "address_2": "SUITE 704",
            "city": "YOUNGSVILLE",
            "state": "LA",
            "postal_code": "70592",
            "telephone_number": "337-451-4511",
            "fax_number": "337-857-6044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED EYECARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-13",
        "last_updated": "2014-12-16",
        "status": "A",
        "authorized_official_last_name": "GRANGER",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OPTOMETRIST, CEO",
        "authorized_official_telephone_number": "337-451-4511",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "LA",
            "license": "1611-644T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2167626",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Granger Eye Studio",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Primary Care Clinic/Center in Youngsville, LA
• Providers in Youngsville, LA by specialty
• Primary Care Clinic/Center in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.