MEDICARE: VISION OPTIQUE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	152W00000X	Optometrist
2	332H00000X	Eyewear Supplier
3	156FX1800X	Optician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134152408
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISION OPTIQUE INC

Provider Business Mailing Address
First Line	:	PO BOX 1950
Second Line	:
City	:	MANDEVILLE
State	:	LA
Zip	:	70470-1950
Country	:	US
Telephone Number	:	985-727-9948
Fax Number	:	985-237-6008

Provider Business Practice Location Address
First Line	:	2997 HIGHWAY 190
Second Line	:
City	:	MANDEVILLE
State	:	LA
Zip	:	70471-3298
Country	:	US
Telephone Number	:	985-727-9948
Fax Number	:	985-237-6008

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RODERICK A GRUENIG
Credential	:
Telephone Number	:	985-727-9948

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	11/21/2007

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Directions to “VISION OPTIQUE INC ” Practice Location

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