Provider Demographics
NPI:1639220411
Name:BOND WROTEN EYE CLINIC
Entity Type:Organization
Organization Name:BOND WROTEN EYE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:HUNTER
Authorized Official - Last Name:BOND
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:985-748-8096
Mailing Address - Street 1:60007 W WAY DR
Mailing Address - Street 2:
Mailing Address - City:AMITE
Mailing Address - State:LA
Mailing Address - Zip Code:70422-4186
Mailing Address - Country:US
Mailing Address - Phone:985-748-8096
Mailing Address - Fax:
Practice Address - Street 1:60007 WEST WAY DRIVE
Practice Address - Street 2:
Practice Address - City:AMITE
Practice Address - State:LA
Practice Address - Zip Code:70422
Practice Address - Country:US
Practice Address - Phone:985-748-8096
Practice Address - Fax:985-748-4376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1445487Medicaid
LA5CJ67Medicare PIN
LA1173500001Medicare NSC