Organization
HIGHLAND CLINIC OPTICAL SHOP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BECKY ANN SMITH (CREDENTIALING SPECIALIST)
(318) 798-4539
Entity
Organization
Contact information
Practice address
1455 E BERT KOUNS LOOP, SUITE #300, SHREVEPORT, LA 71105-5634
(318) 798-4614
Mailing address
1455 E BERT KOUNS LOOP, SUITE #300, SHREVEPORT, LA 71105-5634
(318) 798-4614
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
10/13/2005
Last updated
08/22/2020
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