Organization
BOREING VISION CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JENNIFER SMITH OPTOMETRIST (OWNER)
(337) 474-6161
Entity
Organization
Contact information
Practice address
500 W MCNEESE ST, LAKE CHARLES, LA 70605-5528
(337) 474-6161
(337) 474-6474
Mailing address
500 W MCNEESE ST, LAKE CHARLES, LA 70605-5528
(337) 474-6161
(337) 474-6474
Taxonomy
Speciality
Code
Description
License number
State
152WV0400X
Vision Therapy Optometrist
Primary
904-130T
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BLUECROSS BLUESHIELD
4318819170
LA
Enumeration date
03/15/2007
Last updated
03/15/2022
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