# VISION SOURCE ALEXANDRIA LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356694434
- **Authorized official:** DR. LACY B SHAW O.D. (OWNER/DOCTOR)
- **Authorized official phone:** (318) 442-7787

## Contact information

- **Practice address:** 5615B JACKSON STREET EXT, ALEXANDRIA, LA 71303-2275
- **Practice address phone:** (318) 442-7787
- **Practice address fax:** (318) 443-1654
- **Mailing address:** 5615B JACKSON STREET EXT, ALEXANDRIA, LA 71303-2275
- **Mailing address phone:** (318) 442-7787
- **Mailing address fax:** (318) 443-1654

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | 734-081T | LA | Yes |

## Other

- **Enumeration date:** 10/26/2012
- **Last updated:** 10/26/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1153486 | — | LA |