Individual
MR. WILLARD E MARIONNEAUX JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
6609 MAIN STREET, WINNSBORO, LA 71295
(318) 435-5145
(318) 435-9476
Mailing address
PO BOX 910, WINNSBORO, LA 71295
(318) 435-5145
(318) 435-9476
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
712014T
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1117307
—
LA
01
—
5388880001
PALMETTO
—
Enumeration date
12/12/2006
Last updated
08/20/2007
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