Provider Demographics
NPI:1023332145
Name:AELC LEESVILLE OPTICAL, LLC
Entity type:Organization
Organization Name:AELC LEESVILLE OPTICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:REDMOND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-487-2020
Mailing Address - Street 1:231 WINDERMERE BLVD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3538
Mailing Address - Country:US
Mailing Address - Phone:318-487-2020
Mailing Address - Fax:318-445-7745
Practice Address - Street 1:1106 PORT ARTHUR TERRACE
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-4636
Practice Address - Country:US
Practice Address - Phone:337-392-1994
Practice Address - Fax:337-392-1944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier