Provider Demographics
NPI:1043369341
Name:ABC EYEWEAR FOR CHILDREN
Entity Type:Organization
Organization Name:ABC EYEWEAR FOR CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:P
Authorized Official - Last Name:THIBODEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-989-2600
Mailing Address - Street 1:4630 AMBASSADOR CAFFERY PKWY
Mailing Address - Street 2:STE 414
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6949
Mailing Address - Country:US
Mailing Address - Phone:337-989-2600
Mailing Address - Fax:337-989-2601
Practice Address - Street 1:4630 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:STE 414
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6949
Practice Address - Country:US
Practice Address - Phone:337-989-2600
Practice Address - Fax:337-989-2601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA494559332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA=========0OtherBLUE CROSS BLUE SHIELD