Organization
VISION SOURCE ALEXANDRIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LACY B SHAW O.D. (OWNER/DOCTOR)
(318) 442-7787
Entity
Organization
Contact information
Practice address
5615B JACKSON STREET EXT, ALEXANDRIA, LA 71303-2275
(318) 442-7787
(318) 443-1654
Mailing address
5615B JACKSON STREET EXT, ALEXANDRIA, LA 71303-2275
(318) 442-7787
(318) 443-1654
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
734-081T
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1153486
—
LA
Enumeration date
10/26/2012
Last updated
10/26/2012
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