Provider Demographics
NPI:1730376377
Name:HAWKES, PENNY III
Entity type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:
Last Name:HAWKES
Suffix:III
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 W AIRLINE HWY
Mailing Address - Street 2:SUITE 119
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-3736
Mailing Address - Country:US
Mailing Address - Phone:985-652-3300
Mailing Address - Fax:985-652-1843
Practice Address - Street 1:1036 W AIRLINE HWY
Practice Address - Street 2:SUITE 119
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-3736
Practice Address - Country:US
Practice Address - Phone:985-652-3300
Practice Address - Fax:985-652-1843
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1306991Medicaid