NPIMap

Organization Active NPI

Rivertown Optical Shop

  • Optometrist
  • Kenner, LA
National Provider Identifier
1821326737
Registry record updated Mar 17, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1274431T Issued in LA
Legal business name
RIVERTOWN OPTICAL SHOP
Practice address
400 Williams Blvd
Kenner, LA 70062-7632
Phone
(504) 461-5500
NPI assigned
Dec 4, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2011

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

Authorized official

Name
Paul ProuetNPI 1184686420
Title
Owner
Phone
(504) 782-2990

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 1274431T LA Primary

Addresses

Primary practice location

400 Williams Blvd
Kenner, LA 70062-7632

Mailing address

400 Williams Blvd
Kenner, LA 70062-7632

Other identifiers 1

IdentifierTypeStateIssuer
2136526MedicaidLA

National Provider Directory

National Provider Directory

Locations

400 Williams Blvd
Kenner, LA 70062
Phone (504) 461-5500

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1259884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300320000000",
    "number": "1821326737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 WILLIAMS BLVD",
            "city": "KENNER",
            "state": "LA",
            "postal_code": "700627632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 WILLIAMS BLVD",
            "city": "KENNER",
            "state": "LA",
            "postal_code": "700627632",
            "telephone_number": "504-461-5500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERTOWN OPTICAL SHOP",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-04",
        "last_updated": "2011-03-17",
        "status": "A",
        "authorized_official_last_name": "PROUET",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "504-782-2990"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "LA",
            "license": "1274431T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2136526",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kenner, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2011; 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.