Organization
LA. STATE OPTICAL OF LAKE CHARLES, LA. INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD J. TRICHE (SECRETARY - TREASURER)
(337) 477-3662
Entity
Organization
Contact information
Practice address
628 E PRIEN LAKE RD, LAKE CHARLES, LA 70601-8686
(337) 477-3662
Mailing address
628 E PRIEN LAKE RD, LAKE CHARLES, LA 70601-8686
(337) 477-3662
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1380351
—
LA
Enumeration date
02/27/2007
Last updated
06/21/2011
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