Individual
MATTHEW THIBODEAUX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
13322 HIGHWAY 90 STE L, BOUTTE, LA 70039-3010
(985) 785-8484
(985) 785-8483
Mailing address
1950 OLD GALLOWS RD STE 520, VIENNA, VA 22182-3970
(703) 847-8899
(571) 223-6780
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1859-793AT
LA
Other
Enumeration date
08/01/2017
Last updated
10/26/2020
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