# THIBODAUX VISION CENTER INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568634038
- **Authorized official:** DR. MARK JOSEPH ROY III OD (PRESIDENT)
- **Authorized official phone:** (985) 446-1717

## Contact information

- **Practice address:** 640 ST CHARLES ST, THIBODAUX, LA 70301
- **Practice address phone:** (985) 446-1717
- **Practice address fax:** (985) 446-9542
- **Mailing address:** PO BOX 72, THIBODAUX, LA 70301-0072
- **Mailing address phone:** (985) 446-1717
- **Mailing address fax:** (985) 446-9542

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | 1354488T | LA | Yes |

## Other

- **Enumeration date:** 03/25/2008
- **Last updated:** 03/25/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1128015 | — | LA |