Individual
DR. GLENN COULLARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2421 CHURCH ST, ZACHARY, LA 70791-2710
(225) 654-1061
(225) 654-0791
Mailing address
2421 CHURCH ST, ZACHARY, LA 70791-2710
(225) 654-1061
(225) 654-0791
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
683333T
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1135411
—
LA
Enumeration date
03/21/2006
Last updated
08/07/2012
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