Provider Demographics
NPI:1346215274
Name:HAUTOT, MARC (OD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:HAUTOT
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 1:409 AVENUE F
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-3633
Mailing Address - Country:US
Mailing Address - Phone:985-735-8137
Mailing Address - Fax:985-732-4777
Practice Address - Street 1:409 AVENUE F
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-3633
Practice Address - Country:US
Practice Address - Phone:985-735-8137
Practice Address - Fax:985-732-4777
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1039152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0880022Medicaid
LA1397563Medicaid
LA48531Medicare ID - Type Unspecified
LA1397563Medicaid
LA410043668Medicare PIN
LAT19579Medicare UPIN