# BLUEBONNET VISION

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Bluebonnet Vision LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1801960919
- **Authorized official:** DR. JEFFERY DIBENEDETTO O.D. (OWNER/CEO)
- **Authorized official phone:** (225) 291-2414

## Contact information

- **Practice address:** 4451 BLUEBONNET BLVD, SUITE C, BATON ROUGE, LA 70809-9639
- **Practice address phone:** (225) 291-2414
- **Practice address fax:** (225) 291-2418
- **Mailing address:** 4451 BLUEBONNET BLVD, SUITE C, BATON ROUGE, LA 70809-9639
- **Mailing address phone:** (225) 291-2414
- **Mailing address fax:** (225) 291-2418

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | — | NULL | Yes |
| 152W00000X | Optometrist | — | — | Yes |
| 152WC0802X | Corneal and Contact Management Optometrist | — | NULL | — |
| 152WC0802X | Corneal and Contact Management Optometrist | — | — | — |
| 152WP0200X | Pediatric Optometrist | — | NULL | — |
| 152WP0200X | Pediatric Optometrist | — | — | — |
| 332H00000X | Eyewear Supplier | — | NULL | — |

## Other

- **Enumeration date:** 11/20/2006
- **Last updated:** 10/15/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1013949833 | NPI | LA |
| 01 | — | 1255360525 | NPI | LA |