# DR. GLENN M COULLARD

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1972110401
- **Authorized official:** BERNADETTE MARIE LOEBS (OFFICE MANAGER)
- **Authorized official phone:** (225) 324-5190

## Contact information

- **Practice address:** 11937 FERDINAND STREET, SAINT FRANCISVILLE, LA 70775-4342
- **Practice address phone:** (225) 635-6483
- **Practice address fax:** (225) 658-2424
- **Mailing address:** 156 GOLDEN MEADOW DR, COVINGTON, LA 70433-6604
- **Mailing address phone:** (225) 938-7701
- **Mailing address fax:** (225) 658-2424

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | — | NULL | Yes |
| 152W00000X | Optometrist | — | — | Yes |

## Other

- **Enumeration date:** 09/29/2020
- **Last updated:** 09/29/2020