Organization
EYE CENTRAL MANSFIELD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRADLY LARSON OD (OWNER)
(318) 872-0747
Entity
Organization
Contact information
Practice address
405 POLK ST, MANSFIELD, LA 71052-2400
(318) 872-0747
(318) 716-3376
Mailing address
313 GRIFFIN DR, STONEWALL, LA 71078-5411
(318) 963-1055
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1775-709AT
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2379054
—
LA
Enumeration date
03/26/2018
Last updated
03/26/2018
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