Organization
CUSTOM OPTICAL N.O
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DERRICK DEVRON PERIQUE CAREER DIPOLMA (OWNER)
(504) 408-8771
Entity
Organization
Contact information
Practice address
2416 BENEFIT ST., NEW ORLEANS, LA 70122-4709
(504) 408-8771
Mailing address
2416 BENEFIT ST., NEW ORLEANS, LA 70122-4709
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
LA
Other
Enumeration date
09/22/2016
Last updated
09/22/2016
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