Organization
ST. CHARLES VISION - BOUTTE LLC
Active
Other names
St. Charles Vision Outlet
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY LEACH O.D. (PARTNER/OPTOMETRIST)
(504) 866-7352
Entity
Organization
Contact information
Practice address
13322 HIGHWAY 90, SUITE L, BOUTTE, LA 70039-3039
(985) 785-8484
(985) 785-8483
Mailing address
PO BOX 446, BOUTTE, LA 70039-0446
(985) 785-8484
(985) 785-8483
Taxonomy
Speciality
Code
Description
License number
State
152WC0802X
Corneal and Contact Management Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1451622
—
LA
Enumeration date
08/14/2008
Last updated
01/04/2012
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