Organization
EYEWEAR BOUTIQUE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KAREN S. CHRISTIAN (OFFICE MANAGER)
(337) 948-9504
Entity
Organization
Contact information
Practice address
232 N UNION ST, OPELOUSAS, LA 70570-6208
(337) 948-9504
(337) 942-3545
Mailing address
232 N UNION ST, OPELOUSAS, LA 70570-6208
(337) 948-9504
(337) 942-3545
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
793005T
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0158790001
PTAN
LA
01
—
1477722460
CIGNA/PALMETTO
LA
Enumeration date
02/01/2010
Last updated
02/26/2013
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