Provider Demographics
NPI:1629404645
Name:BAYOU VISION ASSOCIATES, LLC
Entity Type:Organization
Organization Name:BAYOU VISION ASSOCIATES, LLC
Other - Org Name:SANDERS VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:STAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:337-984-9941
Mailing Address - Street 1:1460 S COLLEGE RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2912
Mailing Address - Country:US
Mailing Address - Phone:337-984-9941
Mailing Address - Fax:337-984-8639
Practice Address - Street 1:1460 S COLLEGE RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2912
Practice Address - Country:US
Practice Address - Phone:337-984-9941
Practice Address - Fax:337-984-8639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-23
Last Update Date:2015-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty