Individual
DR. OTIS J BOURG JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O. D.
Contact information
Practice address
832 BELANGER ST, HOUMA, LA 70360-4408
(985) 872-1494
(985) 580-4422
Mailing address
832 BELANGER ST, HOUMA, LA 70360-4408
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
LA666265T
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06110
SPECTERA
LA
05
—
1094196
—
LA
01
—
110894
EYE MED
LA
01
—
BO908019
CLARITY VISION
LA
Enumeration date
10/19/2006
Last updated
03/11/2009
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