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General NPI Number Information
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NPI Number | 1306484290
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Entity Type | Organization
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Legal Business Name | DR. PATRICK FONTENOT OD, LLC
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Dates
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Enumeration Date | 12/11/2019
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Last Update Date | 12/13/2019
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Provider Practice Location Address
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Address Line | 525 N. CITIES SERVICE HWY WALMART VISION CENTER
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City | SULPHUR
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State | LA
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Zip | 70663-4107
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Country | US
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Telephone | 337-625-9075
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Fax | 337-625-8105
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Provider Business Mailing Address
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Address Line | 525 N. CITIES SERVICE HWY WALMART VISION CENTER
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City | SULPHUR
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State | LA
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Zip | 70663-4107
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Country | US
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Telephone | 337-625-9075
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Fax | 337-625-8105
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. PATRICK MARTIN FONTENOT
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Credential | OD
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Telephone | 337-625-9075
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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 |
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License Number State |
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