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General NPI Number Information
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NPI Number | 1497901540
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Entity Type | Organization
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Legal Business Name | INFINITE VISION LLC
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Dates
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Enumeration Date | 08/08/2008
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Last Update Date | 03/14/2024
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Provider Practice Location Address
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Address Line | 4050 LONESOME ROAD SUITE A
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City | MANDEVILLE
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State | LA
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Zip | 70448
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Country | US
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Telephone | 985-789-7624
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Fax | 985-777-9090
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Provider Business Mailing Address
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Address Line | 4050 LONESOME ROAD SUITE A
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City | MANDEVILLE
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State | LA
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Zip | 70448
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Country | US
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Telephone | 985-789-7624
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Fax | 985-777-9090
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Authorized Official
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Title or Position | OWNER
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Name | DR. KATHERINE WONCH
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Credential | O.D.
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Telephone | 985-789-7624
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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 | 1360-494T
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License Number State | LA
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