Provider Demographics
NPI:1548569007
Name:OPTICAL ZONE, LLC
Entity type:Organization
Organization Name:OPTICAL ZONE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:SWEARINGEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:318-524-2226
Mailing Address - Street 1:7607 YOUREE DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5501
Mailing Address - Country:US
Mailing Address - Phone:318-524-2226
Mailing Address - Fax:
Practice Address - Street 1:2611 GREENWOOD RD
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-3907
Practice Address - Country:US
Practice Address - Phone:318-212-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPTICAL ZONE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-23
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1578819Medicaid
LA1041998Medicaid
LA5K639B787Medicare PIN
LAH87909Medicare UPIN
LA5J481B787Medicare PIN
LA1041998Medicaid
LA4F257CS65Medicare PIN
LAB89834Medicare UPIN
LA1578819Medicaid