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Individual
MS. VIVIAN MARIE FOUNTAIN
Active
Individual
MS. VIVIAN MARIE FOUNTAIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1804-738AT
LA
152W00000X
Optometrist
MS 638
MS
152W00000X
Optometrist
MS638
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
94199
TPA
MS
01
—
MS 638
STATE LICENSE
MS
Enumeration date
09/29/2006
Last updated
03/07/2023
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