Provider Demographics
NPI:1093855009
Name:FAVRE, MARION P
Entity Type:Individual
Prefix:MS
First Name:MARION
Middle Name:P
Last Name:FAVRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 PONCHARTRAIN DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-4329
Mailing Address - Country:US
Mailing Address - Phone:985-641-1195
Mailing Address - Fax:985-641-1193
Practice Address - Street 1:401 PONCHARTRAIN DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-4329
Practice Address - Country:US
Practice Address - Phone:985-641-1195
Practice Address - Fax:985-641-1193
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NOT REQUIRED IN LA156FX1800X
LA156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician