Healthcare Provider Details

I. General information

NPI: 1659631323
Provider Name (Legal Business Name): BEC VISION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2012
Last Update Date: 05/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 N BROADWAY ST
CHURCH POINT LA
70525-2914
US

IV. Provider business mailing address

315 N BROADWAY ST
CHURCH POINT LA
70525-2914
US

V. Phone/Fax

Practice location:
  • Phone: 337-684-0018
  • Fax: 337-634-0715
Mailing address:
  • Phone: 337-684-0018
  • Fax: 337-634-0715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. CLAUDETTE SMITH-BOUDREAUX
Title or Position: OFFICE MANAGER
Credential: O.D.
Phone: 337-684-0018