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Organization
ADVANCED FAMILY EYECARE, LLC
Active
Organization
ADVANCED FAMILY EYECARE, LLC
Active
Other names
Advanced Family Eyecare
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHANE B FONTENOT OD (OWNER)
(337) 263-3058
Entity
Organization
Contact information
Practice address
1702 JOHNSON ST, JENNINGS, LA 70546-3624
(337) 824-1112
(337) 824-9112
Mailing address
1702 JOHNSON ST, JENNINGS, LA 70546-3624
(337) 824-1112
(337) 824-9112
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1540
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1020818
—
LA
Enumeration date
08/29/2007
Last updated
07/25/2023
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