Provider Demographics
NPI:1558622563
Name:HAUGHTON VISION, LLC
Entity Type:Organization
Organization Name:HAUGHTON VISION, LLC
Other - Org Name:HAUGHTON VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADFORD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:318-949-6085
Mailing Address - Street 1:4010 HWY 80
Mailing Address - Street 2:
Mailing Address - City:HAUGHTON
Mailing Address - State:LA
Mailing Address - Zip Code:71037
Mailing Address - Country:US
Mailing Address - Phone:318-949-6085
Mailing Address - Fax:318-949-6084
Practice Address - Street 1:4010 HWY 80
Practice Address - Street 2:
Practice Address - City:HAUGHTON
Practice Address - State:LA
Practice Address - Zip Code:71037
Practice Address - Country:US
Practice Address - Phone:318-949-6085
Practice Address - Fax:318-949-6084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1586-619T152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2120069Medicaid