Provider Demographics
NPI:1790961340
Name:BETTER VISION OF NEW IBERIA, INC
Entity Type:Organization
Organization Name:BETTER VISION OF NEW IBERIA, INC
Other - Org Name:IBERIA VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:LANDRUM
Authorized Official - Suffix:SR
Authorized Official - Credentials:OD
Authorized Official - Phone:337-365-7219
Mailing Address - Street 1:921 S LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-6303
Mailing Address - Country:US
Mailing Address - Phone:337-365-7219
Mailing Address - Fax:337-367-3837
Practice Address - Street 1:921 S LEWIS ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-6303
Practice Address - Country:US
Practice Address - Phone:337-365-7219
Practice Address - Fax:337-367-3837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3960812003332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA0234120001Medicare NSC