Otis J Bourg Jr., O. D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

LA666265T Issued in LA

Practice address

832 Belanger St
Houma, LA 70360-4408

Phone

(985) 872-1494

Fax

(985) 580-4422

NPI assigned

Oct 19, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1236729600000",
    "number": "1114009313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "832 BELANGER ST",
            "city": "HOUMA",
            "state": "LA",
            "postal_code": "703604408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "832 BELANGER ST",
            "city": "HOUMA",
            "state": "LA",
            "postal_code": "703604408",
            "telephone_number": "985-872-1494",
            "fax_number": "985-580-4422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURG",
        "first_name": "OTIS",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "O. D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-19",
        "last_updated": "2009-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "LA",
            "license": "LA666265T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1094196",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYE MED",
            "identifier": "110894",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SPECTERA",
            "identifier": "06110",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLARITY VISION",
            "identifier": "BO908019",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sharon Boudreaux
• Stephanie Hebert Boudreaux, PMHNP
• John William Bour, CRNA
• Geraldine R Bourdeaux, LPC
• Hannah Bourg, AA
• Brody Jaymes Bourgeois
• Claire A Bourgeois
• Kristy Trosclair Bourgeois, PT
• Nicole Bourgeois, LMFT
• Ralph James Bourgeois, M.D.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.