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NPI Code Detail

MEDICARE: LAURA LEIGH THOMPSON BUISSON OD

MEDICARE: LAURA LEIGH THOMPSON BUISSON OD
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
1152W00000XOptometrist1596-629TLA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1760796577
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA LEIGH THOMPSON BUISSON OD
Provider Business Mailing Address
First Line : 900 N CANAL BLVD
Second Line :
City : THIBODAUX
State : LA
Zip : 70301-8096
Country : US
Telephone Number : 985-446-3226
Fax Number :
Provider Business Practice Location Address
First Line : 900 N CANAL BLVD
Second Line :
City : THIBODAUX
State : LA
Zip : 70301-8096
Country : US
Telephone Number : 985-446-3226
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2010
Last Update Date : 09/17/2012

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