=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427144658
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAMILE L. CHIASSON, O.D., APOC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 318 N CANAL BLVD
-----------------------------------------------------
City | THIBODAUX
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70301-2996
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-446-3276
-----------------------------------------------------
Fax | 985-446-3278
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 318 N CANAL BLVD
-----------------------------------------------------
City | THIBODAUX
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70301-2996
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-446-3276
-----------------------------------------------------
Fax | 985-446-3278
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. LINDA N. GROS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 985-446-3276
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 885-189T
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------