Advanced Eyecare, LLC
Organization Active NPI Primary Care Clinic/Center · Youngsville, LA
NPI 1043645666 · NPPES record last updated Dec 16, 2014
Key facts
- NPI
- 1043645666
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- License
- 1611-644T (LA)
- Legal business name
- ADVANCED EYECARE, LLC
- Practice address
- 107 Centre Sarcelle Blvd.
Suite 704
Youngsville, LA 70592 - Phone
- (337) 451-4511
- Fax
- (337) 857-6044
- NPI assigned
- Sep 13, 2013
- Organization subpart
- No
Authorized official
- Name
- Dr. Gary J Granger, OD
- Title
- Optometrist, Ceo
- Phone
- (337) 451-4511
Practitioners 1
-
Gary J. Granger, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20131217000934 | LA | Part B Supplier - Clinic/Group Practice | 5193952281 |
Receives reassigned benefits from 1 practitioner Practice locations: Youngsville, LA |
National Provider Directory
Locations
107 Centre Sarcelle Blvd
Youngsville, LA 70592
Phone (337) 857-3565
107 Centre Sarcelle Blvd
Ste 704
Youngsville, LA 70592
Phone (337) 451-4511
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | 1611-644T | LA | Yes |
Addresses
Primary practice location
107 Centre Sarcelle Blvd.
Suite 704
Youngsville, LA 70592
Mailing address
107 Centre Sarcelle Blvd.
Suite 704
Youngsville, LA 70592
Phone (337) 451-4511
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2167626 | Medicaid | LA |
Other names
- Granger Eye Studio
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All providers in Youngsville, LA · Primary Care Clinic/Center in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 16, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.