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General NPI Number Information
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NPI Number | 1306078365
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Entity Type | Organization
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Legal Business Name | PAUL B DUPONT'S OPTICAL WORLD, LLC
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Dates
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Enumeration Date | 08/10/2009
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Last Update Date | 08/13/2009
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Provider Practice Location Address
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Address Line | 4020 JACKSON STREET EXT
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City | ALEXANDRIA
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State | LA
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Zip | 71303-2701
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Country | US
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Telephone | 318-442-4230
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Fax | 318-442-9537
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Provider Business Mailing Address
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Address Line | 4020 JACKSON STREET EXT
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City | ALEXANDRIA
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State | LA
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Zip | 71303-2701
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Country | US
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Telephone | 318-442-4230
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Fax | 318-442-9537
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Authorized Official
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Title or Position | OWNER
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Name | DR. PAUL BRADLEY DUPONT
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Credential | O.D.
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Telephone | 318-442-4230
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | LA978-263T
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License Number State | LA
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