Healthcare Provider Details

I. General information

NPI: 1134152408
Provider Name (Legal Business Name): VISION OPTIQUE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 11/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2997 HIGHWAY 190
MANDEVILLE LA
70471-3298
US

IV. Provider business mailing address

PO BOX 1950
MANDEVILLE LA
70470-1950
US

V. Phone/Fax

Practice location:
  • Phone: 985-727-9948
  • Fax: 985-237-6008
Mailing address:
  • Phone: 985-727-9948
  • Fax: 985-237-6008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: MR. RODERICK A GRUENIG
Title or Position: PRESIDENT
Credential:
Phone: 985-727-9948