Provider Demographics
NPI:1447458286
Name:GANDY EYE CARE A PROFESSIONAL
Entity type:Organization
Organization Name:GANDY EYE CARE A PROFESSIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STACY
Authorized Official - Middle Name:G
Authorized Official - Last Name:GANDY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:318-728-2299
Mailing Address - Street 1:107 MAXWELL DR
Mailing Address - Street 2:
Mailing Address - City:RAYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71269-5558
Mailing Address - Country:US
Mailing Address - Phone:318-728-2299
Mailing Address - Fax:318-728-0081
Practice Address - Street 1:107 MAXWELL DR
Practice Address - Street 2:
Practice Address - City:RAYVILLE
Practice Address - State:LA
Practice Address - Zip Code:71269-5558
Practice Address - Country:US
Practice Address - Phone:318-728-2299
Practice Address - Fax:318-728-0081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2455BOtherBLUECROSSBLUESHIELD OF LA
LA1945811Medicaid
0878870001Medicare NSC
LA5D804Medicare PIN