# MS. VIVIAN MARIE FOUNTAIN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1790877413
- **Gender:** F
- **Credential:** O.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | 1804-738AT | LA | Yes |
| 152W00000X | Optometrist | MS 638 | MS | — |
| 152W00000X | Optometrist | MS638 | MS | — |

## Other

- **Enumeration date:** 09/29/2006
- **Last updated:** 03/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 94199 | TPA | MS |
| 01 | — | MS 638 | STATE LICENSE | MS |