Mitchell Neil Broussard, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

1105-195T Issued in LA

Practice address

5725 Johnston St
Suite 2314
Lafayette, LA 70503-5315

Phone

(337) 984-2410

Fax

(337) 984-2416

NPI assigned

Sep 30, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

University of Houston - College of Optometry, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Today'S Eyecare, LLCGroup PAC ID 6608865548, 4 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Today'S Eyecare, LLC

  • Optometrist
  • Lafayette, LA
  • NPI 1710007000
  Medicare reassignment Care Compare group NPD
• Capital Eyes LLC

  • Optometrist
  • Baton Rouge, LA
  • NPI 1245544675
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329696000000",
    "number": "1013904473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5725 JOHNSTON ST",
            "address_2": "SUITE 2314",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705035315",
            "telephone_number": "337-984-2410",
            "fax_number": "337-984-2416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5725 JOHNSTON ST",
            "address_2": "SUITE 2314",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705035315",
            "telephone_number": "337-984-2410",
            "fax_number": "337-984-2416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROUSSARD",
        "first_name": "MITCHELL",
        "middle_name": "NEIL",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-30",
        "last_updated": "2012-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "LA",
            "license": "1105-195T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Krystle Robichaux Broussard
• Leenora Broussard, R.PH.
• Mandi Broussard
• Mary Elizabeth Broussard, B.A., B.S.
• Melanie Cavalier Broussard
• Morgan Broussard, SLP
• Nancy Rebecca Fisher Broussard, OD
• Natalie Broussard, N.P.
• Patricia Broussard
• Preston Broussard

• Optometrist in Lafayette, LA
• Providers in Lafayette, LA by specialty
• Optometrist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.