Provider Demographics
NPI:1811220775
Name:VISION CENTER OF THE SOUTH, INC.
Entity Type:Organization
Organization Name:VISION CENTER OF THE SOUTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER-OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MADELINE
Authorized Official - Middle Name:MAXINE
Authorized Official - Last Name:BORNE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:504-482-1290
Mailing Address - Street 1:4200 CANAL ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-5984
Mailing Address - Country:US
Mailing Address - Phone:504-482-1290
Mailing Address - Fax:504-482-1292
Practice Address - Street 1:4200 CANAL ST
Practice Address - Street 2:SUITE D
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-5984
Practice Address - Country:US
Practice Address - Phone:504-482-1290
Practice Address - Fax:504-482-1292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1007-345T332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1363863Medicaid
LA48756Medicare PIN
LA1363863Medicaid