| Organization Name: | ADVANCED EYECARE, LLC |
| NPI Number: | 1043645666 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GARY J GRANGER (OPTOMETRIST, CEO) |
| Mailing Address: | 107 Centre Sarcelle Blvd. Suite 704 Youngsville |
| State: | LA US |
| Postal Code: | 70592 |
| Phone Number: | 3374514511 |
| Fax Number: | 3378576044 |
| NPI Enumeration Date: | 09/13/2013 |
| NPI Last Update Date: | 12/16/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 1611-644T |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |