Healthcare Provider Details

I. General information

NPI: 1790953651
Provider Name (Legal Business Name): FAMILY VISION CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2008
Last Update Date: 10/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 CORPORATE DR STE A
HOUMA LA
70360-2766
US

IV. Provider business mailing address

126 CORPORATE DR STE A
HOUMA LA
70360-2766
US

V. Phone/Fax

Practice location:
  • Phone: 985-851-2211
  • Fax:
Mailing address:
  • Phone: 985-851-2211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. LAWRENCE BREAUX
Title or Position: OWNER
Credential: O.D.
Phone: 985-851-2211