# ST. CHARLES VISION - BOUTTE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** St. Charles Vision Outlet
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235385873
- **Authorized official:** DR. TIMOTHY LEACH O.D. (PARTNER/OPTOMETRIST)
- **Authorized official phone:** (504) 866-7352

## Contact information

- **Practice address:** 13322 HIGHWAY 90, SUITE L, BOUTTE, LA 70039-3039
- **Practice address phone:** (985) 785-8484
- **Practice address fax:** (985) 785-8483
- **Mailing address:** PO BOX 446, BOUTTE, LA 70039-0446
- **Mailing address phone:** (985) 785-8484
- **Mailing address fax:** (985) 785-8483

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152WC0802X | Corneal and Contact Management Optometrist | — | NULL | Yes |
| 152WC0802X | Corneal and Contact Management Optometrist | — | — | Yes |

## Other

- **Enumeration date:** 08/14/2008
- **Last updated:** 01/04/2012