St. Charles Vision - Boutte LLC

Primary specialty

Corneal and Contact Management OptometristTaxonomy code 152WC0802X

Legal business name

ST. CHARLES VISION - BOUTTE LLC

Doing business as

St. Charles Vision Outlet

Practice address

13322 Highway 90
Suite L
Boutte, LA 70039-3039

Phone

(985) 785-8484

Fax

(985) 785-8483

NPI assigned

Aug 14, 2008

Last updated

Jan 4, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Timothy Leach, O.D.

Title

Partner/Optometrist

Phone

(504) 866-7352

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• St. Charles Vision Outlet Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Charles Gene Glaser, OD

  • Optometrist
  • New Orleans, LA
  • NPI 1104818384

  Corneal and Contact Management

  NPD (past)

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

{
    "created_epoch": "1218672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1325635200000",
    "number": "1235385873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 446",
            "city": "BOUTTE",
            "state": "LA",
            "postal_code": "700390446",
            "telephone_number": "985-785-8484",
            "fax_number": "985-785-8483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13322 HIGHWAY 90",
            "address_2": "SUITE L",
            "city": "BOUTTE",
            "state": "LA",
            "postal_code": "700393039",
            "telephone_number": "985-785-8484",
            "fax_number": "985-785-8483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. CHARLES VISION - BOUTTE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-14",
        "last_updated": "2012-01-04",
        "status": "A",
        "authorized_official_last_name": "LEACH",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "PARTNER/OPTOMETRIST",
        "authorized_official_telephone_number": "504-866-7352",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1451622",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Charles Vision Outlet",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Roxanne Russ, MSW,CSW
• Jordan Ashley Samaha
• Keli Doles Sanders, DPT
• Sav Mor Drugs Inc
• Michael Thomas Simmons, PHARMD
• Sabina Strat, MS
• Sammi Taylor, ATC
• The Arc of St. Charles, Inc.
• The Arc of St. Charles, Inc.
• The Arc of St. Charles, Inc.

• Corneal and Contact Management Optometrist in Boutte, LA
• Providers in Boutte, LA by specialty
• Corneal and Contact Management Optometrist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2012; 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.