Organization
BLUEBONNET VISION
Active
Other names
Bluebonnet Vision LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFERY DIBENEDETTO O.D. (OWNER/CEO)
(225) 291-2414
Entity
Organization
Contact information
Practice address
4451 BLUEBONNET BLVD, SUITE C, BATON ROUGE, LA 70809-9639
(225) 291-2414
(225) 291-2418
Mailing address
4451 BLUEBONNET BLVD, SUITE C, BATON ROUGE, LA 70809-9639
(225) 291-2414
(225) 291-2418
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
152WC0802X
Corneal and Contact Management Optometrist
—
—
152WP0200X
Pediatric Optometrist
—
—
332H00000X
Eyewear Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1013949833
NPI
LA
01
—
1255360525
NPI
LA
Enumeration date
11/20/2006
Last updated
10/15/2009
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