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General NPI Number Information
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NPI Number | 1174564280
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Entity Type | Organization
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Legal Business Name | BROUSSARD EYE ASSOCIATES, LLLP
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Dates
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Enumeration Date | 06/09/2006
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 138 GATEWAY ST
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City | BEAUMONT
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State | TX
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Zip | 77701-3706
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Country | US
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Telephone | 409-835-2041
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Fax | 409-838-4518
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Provider Business Mailing Address
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Address Line | 138 GATEWAY ST
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City | BEAUMONT
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State | TX
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Zip | 77701-3706
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Country | US
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Telephone | 409-835-2041
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Fax | 409-838-4518
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Authorized Official
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Title or Position | OWNER
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Name | DR. WENDY L BROUSSARD
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Credential | OD
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Telephone | 409-835-2041
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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 | 05101TG
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License Number State | TX
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