MEDICARE: PAUL B DUPONT'S OPTICAL WORLD, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier	LA978-263T	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306078365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAUL B DUPONT'S OPTICAL WORLD, LLC

Provider Business Mailing Address
First Line	:	4020 JACKSON STREET EXT
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71303-2701
Country	:	US
Telephone Number	:	318-442-4230
Fax Number	:	318-442-9537

Provider Business Practice Location Address
First Line	:	4020 JACKSON STREET EXT
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71303-2701
Country	:	US
Telephone Number	:	318-442-4230
Fax Number	:	318-442-9537

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PAUL BRADLEY DUPONT
Credential	:	O.D.
Telephone Number	:	318-442-4230

Provider Enumeration Date	:	08/10/2009
Last Update Date	:	08/13/2009

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