# EYE CENTRAL MANSFIELD LLC

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

## Provider details

- **NPI number:** 1457856296
- **Authorized official:** BRADLY LARSON OD (OWNER)
- **Authorized official phone:** (318) 872-0747

## Contact information

- **Practice address:** 405 POLK ST, MANSFIELD, LA 71052-2400
- **Practice address phone:** (318) 872-0747
- **Practice address fax:** (318) 716-3376
- **Mailing address:** 313 GRIFFIN DR, STONEWALL, LA 71078-5411
- **Mailing address phone:** (318) 963-1055

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | 1775-709AT | LA | Yes |

## Other

- **Enumeration date:** 03/26/2018
- **Last updated:** 03/26/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 2379054 | — | LA |