Healthcare Provider Details

I. General information

NPI: 1396742698
Provider Name (Legal Business Name): R HUNTER BOND O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60007 WEST WAY DRIVE
AMITE LA
70422
US

IV. Provider business mailing address

60007 W WAY DR
AMITE LA
70422-4186
US

V. Phone/Fax

Practice location:
  • Phone: 985-748-8096
  • Fax: 985-748-4376
Mailing address:
  • Phone: 985-748-8096
  • Fax: 985-748-4376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1216-377AT
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1216-377T
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: