Provider Demographics
NPI:1275623712
Name:BILELLO, JOHN RAY (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RAY
Last Name:BILELLO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 BLAKE CT
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-3504
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16759 HIGHWAY 3235
Practice Address - Street 2:STORE 502
Practice Address - City:GALLIANO
Practice Address - State:LA
Practice Address - Zip Code:70354
Practice Address - Country:US
Practice Address - Phone:985-632-4747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA774-212T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist