Provider Demographics
NPI:1316040314
Name:CHIASSON, CAMILE LOUIS (OD)
Entity Type:Individual
Prefix:DR
First Name:CAMILE
Middle Name:LOUIS
Last Name:CHIASSON
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 1:900 N CANAL BLVD
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-8096
Mailing Address - Country:US
Mailing Address - Phone:985-446-3276
Mailing Address - Fax:985-446-3278
Practice Address - Street 1:900 N CANAL BLVD
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-8096
Practice Address - Country:US
Practice Address - Phone:985-446-3276
Practice Address - Fax:985-446-3278
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA885189T152W00000X
LAMD026103207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2211BOtherBLUE CROSS
LA0153010001OtherDME
LA1312550Medicaid
T19584Medicare UPIN
LA1312550Medicaid