# ST. CHARLES VISION OUTLET ELMWOOD, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** ST. CHARLES VISION ELMWOOD
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114902251
- **Authorized official:** MRS. JANET DUPLESSIS (INSURANCE ADMINISTRATOR)
- **Authorized official phone:** (504) 247-9116

## Contact information

- **Practice address:** 837 S CLEARVIEW PKWY, JEFFERSON, LA 70121-3119
- **Practice address phone:** (504) 733-0406
- **Practice address fax:** (504) 733-0801
- **Mailing address:** 837 S CLEARVIEW PKWY, JEFFERSON, LA 70121-3119
- **Mailing address phone:** (504) 733-0406
- **Mailing address fax:** (504) 733-0801

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | 1079242T | LA | Yes |

## Other

- **Enumeration date:** 12/13/2005
- **Last updated:** 06/13/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 410026332 | MEDICARE RAILROAD | LA |