Individual
LARRY E BLACKMON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
303 MCMILLAN RD, WEST MONROE, LA 71291-8316
(318) 387-7257
(318) 325-7034
Mailing address
303 MCMILLAN RD, WEST MONROE, LA 71291-8316
(318) 387-7257
(318) 325-7034
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
693-077T
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0617300002
PALMETTO
LA
05
—
1097721
—
LA
01
—
2353B
BLUE CROSS OF LA
LA
01
—
2864
DAVIS VISION
LA
01
—
LA0693
EYEMED
LA
Enumeration date
02/01/2007
Last updated
02/05/2008
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