Organization
ALEXANDRIA EYE AND LASER CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OCTAVIA JACKSON WILLIAMS (CREDENTIALING SPECIALIST)
(318) 561-0946
Entity
Organization
Contact information
Practice address
206 JACK MILLER RD, VILLE PLATTE, LA 70586-5639
(337) 506-2121
(318) 445-7745
Mailing address
231 WINDERMERE BLVD, ALEXANDRIA, LA 71303-3538
(318) 487-2020
(318) 445-7745
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
207W00000X
Ophthalmology Physician
—
—
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1441210
—
LA
01
—
DC4592
RAILROAD MEDICARE
LA
Enumeration date
10/20/2009
Last updated
01/19/2022
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