Active NPI
Vivian Marie Fountain, O.D.
- Optometrist
- Houma, LA
National Provider Identifier
1790877413
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1804-738AT
- Practice address
- 130 Enterprise Dr
Houma, LA 70360-2443 - Phone
- (985) 872-2020
- Fax
- (985) 872-2069
- NPI assigned
- Sep 29, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | MS638 | MS | |
| Optometrist | 152W00000X | MS 638 | MS | |
| Optometrist | 152W00000X | 1804-738AT | LA | Primary |
Addresses
Primary practice location
130 Enterprise Dr
Houma, LA 70360-2443
Mailing address
1950 Old Gallows Rd Ste 520
Vienna, VA 22182-3970
Phone (703) 847-8899
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 94199 | Other | MS | TPA |
| MS 638 | Other | MS | STATE LICENSE |
Other names 1
- Dr. Vivian Marie Matthews
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1804-738AT | LA | MD | Optometrist |
| MS 638 | MS | MD | Optometrist |
| MS638 | MS | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159488000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1790877413",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1950 OLD GALLOWS RD STE 520",
"city": "VIENNA",
"state": "VA",
"postal_code": "221823970",
"telephone_number": "703-847-8899",
"fax_number": "571-223-6780"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "130 ENTERPRISE DR",
"city": "HOUMA",
"state": "LA",
"postal_code": "703602443",
"telephone_number": "985-872-2020",
"fax_number": "985-872-2069"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FOUNTAIN",
"first_name": "VIVIAN",
"middle_name": "MARIE",
"name_prefix": "Ms.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-29",
"last_updated": "2023-03-07",
"certification_date": "2021-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MS",
"license": "MS638",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MS",
"license": "MS 638",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "LA",
"license": "1804-738AT",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TPA",
"identifier": "94199",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "MS 638",
"state": "MS"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "VIVIAN",
"last_name": "MATTHEWS",
"middle_name": "MARIE",
"prefix": "DR.",
"credential": "O.D.",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Houma, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.