Healthcare Provider Details

I. General information

NPI: 1518944826
Provider Name (Legal Business Name): DARBY CHARLES CHIASSON OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16140 WEST MAIN ST
CUT OFF LA
70345
US

IV. Provider business mailing address

16140 WEST MAIN ST
CUT OFF LA
70345
US

V. Phone/Fax

Practice location:
  • Phone: 985-632-2884
  • Fax: 985-632-6640
Mailing address:
  • Phone: 985-632-2884
  • Fax: 985-632-6640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberLA1271430T
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: