# ST. CHARLES VISION OUTLET MANDEVILLE, LLC

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

## Provider details

- **NPI number:** 1952428005
- **Authorized official:** MRS. KRISTY G ROUSSEL (OFFICE MANAGER)
- **Authorized official phone:** (985) 626-8103

## Contact information

- **Practice address:** 1844 N. CAUSEWAY BLVD., MANDEVILLE, LA 70471
- **Practice address phone:** (985) 626-8103
- **Mailing address:** 1844 N. CAUSEWAY BLVD., MANDEVILLE, LA 70471
- **Mailing address phone:** (985) 626-8103
- **Mailing address fax:** (985) 626-5571

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | 1318453T | LA | Yes |

## Other

- **Enumeration date:** 03/23/2007
- **Last updated:** 06/11/2014