NPIMap

Organization Active NPI

Rivertown Optical LLC

  • Optician
  • Slidell, LA
National Provider Identifier
1699455949
Registry record updated Jul 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OpticianTaxonomy code 156FX1800X
Legal business name
RIVERTOWN OPTICAL LLC
Practice address
401 Pontchartrain Drive Ste a
Slidell, LA 70458
Phone
(985) 641-1195
Fax
(985) 641-1193
NPI assigned
Jul 21, 2023
Last updated
Jul 21, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
RIVERTOWN OPTICAL LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 21, 2023

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

Authorized official

Name
Ms. Marion Pollet FavreNPI 1093855009
Title
Owner
Phone
(985) 641-1195

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OpticianGroup: 193400000X SINGLE SPECIALTY GROUP 156FX1800X Primary

Addresses

Primary practice location

401 Pontchartrain Drive Ste a
Slidell, LA 70458

Mailing address

401 Pontchartrain Drive Ste a
Slidell, LA 70458
Phone (985) 641-1195

Other identifiers 1

IdentifierTypeStateIssuer
1541176MedicaidLA

National Provider Directory

National Provider Directory
Tax ID family
Rivertown Optical LLC2 organizations share this tax ID, including this one
Part of
Rivertown Optical LLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

401 Pontchartrain Dr
#A
Slidell, LA 70458
Phone (985) 641-1195

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1689897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689897600000",
    "number": "1699455949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 PONTCHARTRAIN DRIVE STE A",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "70458",
            "telephone_number": "985-641-1195",
            "fax_number": "985-641-1193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 PONTCHARTRAIN DRIVE STE A",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "70458",
            "telephone_number": "985-641-1195",
            "fax_number": "985-641-1193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERTOWN OPTICAL LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RIVERTOWN OPTICAL LLC",
        "enumeration_date": "2023-07-21",
        "last_updated": "2023-07-21",
        "certification_date": "2023-07-21",
        "status": "A",
        "authorized_official_last_name": "FAVRE",
        "authorized_official_first_name": "MARION",
        "authorized_official_middle_name": "POLLET",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "985-641-1195",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1541176",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Slidell, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2023; 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.