# VAN M ARDOIN, M.D., A MEDICAL CORPORATION

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

## Provider details

- **NPI number:** 1962679647
- **Authorized official:** DR. VAN M ARDOIN MD (OWNER)
- **Authorized official phone:** (985) 876-6980

## Contact information

- **Practice address:** 603 DUNN ST, HOUMA, LA 70360-4707
- **Practice address phone:** (985) 876-6980
- **Practice address fax:** (985) 876-6975
- **Mailing address:** 603 DUNN ST, HOUMA, LA 70360-4707
- **Mailing address phone:** (985) 876-6980
- **Mailing address fax:** (985) 876-6975

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | 011488 | LA | Yes |

## Other

- **Enumeration date:** 05/13/2008
- **Last updated:** 05/26/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1146170 | — | LA |