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General NPI Number Information
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NPI Number | 1093984387
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Entity Type | Organization
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Legal Business Name | J.S. FONTENOT
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Dates
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Enumeration Date | 02/21/2008
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Last Update Date | 05/30/2008
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Provider Practice Location Address
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Address Line | 111 CALCASIEU ST
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City | VILLE PLATTE
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State | LA
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Zip | 70586-4401
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Country | US
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Telephone | 337-363-6060
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Fax | 337-363-3649
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Provider Business Mailing Address
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Address Line | 111 CALCASIEU ST
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City | VILLE PLATTE
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State | LA
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Zip | 70586-4401
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Country | US
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Telephone | 337-363-6060
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Fax | 337-363-3649
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. J.S. FONTENOT
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Credential | O.D.
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Telephone | 337-363-6060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 640286T
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License Number State | LA
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