NPIMap

Organization Active NPI

Shenandoah Eye Clinic

  • Eyewear Supplier
  • Baton Rouge, LA
National Provider Identifier
1497707780
Registry record updated Jul 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
License
LA773206T Issued in LA
Legal business name
SHENANDOAH EYE CLINIC
Practice address
5237 Jones Creek Road
Baton Rouge, LA 70817-2124
Phone
(225) 755-3937
Fax
(225) 755-2272
NPI assigned
May 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2014

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

Authorized official

Name
Dr. Edwin F Adams III, OD
Title
Optometrist/Owner/Ceo
Phone
(225) 755-3937

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X
Corneal and Contact Management OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152WC0802X
Sports Vision OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152WS0006X
Eyewear Supplier 332H00000X LA773206T LA Primary

Addresses

Primary practice location

5237 Jones Creek Road
Baton Rouge, LA 70817-2124

Mailing address

5237 Jones Creek Road
Baton Rouge, LA 70817-2124
Phone (225) 755-3937

Other identifiers 2

IdentifierTypeStateIssuer
0699540001OtherLAMEDICARE SUPPLIER #
1196519MedicaidLA

Other names 1

  • The Lens Source Former legal business name

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404864000000",
    "number": "1497707780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5237 JONES CREEK ROAD",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708172124",
            "telephone_number": "225-755-3937",
            "fax_number": "225-755-2272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5237 JONES CREEK ROAD",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708172124",
            "telephone_number": "225-755-3937",
            "fax_number": "225-755-2272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHENANDOAH EYE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-16",
        "last_updated": "2014-07-09",
        "status": "A",
        "authorized_official_last_name": "ADAMS",
        "authorized_official_first_name": "EDWIN",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "OPTOMETRIST/OWNER/CEO",
        "authorized_official_telephone_number": "225-755-3937",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WS0006X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Sports Vision",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "LA",
            "license": "LA773206T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE SUPPLIER #",
            "identifier": "0699540001",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1196519",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Lens Source",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Baton Rouge, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.