Provider Demographics
NPI:1508123050
Name:CENTER FOR VISION DEVELOPMENT
Entity Type:Organization
Organization Name:CENTER FOR VISION DEVELOPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:985-447-2393
Mailing Address - Street 1:417 SAINT MARY ST
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-2724
Mailing Address - Country:US
Mailing Address - Phone:985-447-2393
Mailing Address - Fax:985-447-2399
Practice Address - Street 1:417 SAINT MARY ST
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-2724
Practice Address - Country:US
Practice Address - Phone:985-447-2393
Practice Address - Fax:985-447-2399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-20
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1411553T261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center