Individual
LOUISEMENE DUBOURG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OPTICAN
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
VUT5575
NY
156FX1800X
Optician
Primary
55 009252
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
900883361
BLUE CROSS, BLUE SHIELD, AETNA, KAISER-PERMANENTE,DAVIS VISION, HEALTH FIRST.
NY
05
—
900883361
—
NY
Enumeration date
11/04/2012
Last updated
11/04/2012
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