Cory James Boudreaux, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

1563-594T Issued in LA

Practice address

2308 S Burnside Ave
Gonzales, LA 70737-4643

Phone

(225) 644-7525

Fax

(225) 647-3710

NPI assigned

Jul 25, 2008

Last updated

Aug 4, 2022By the provider in NPPES

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

Southern College of Optometry, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Our Lady of the Lake Physician Group LLCGroup PAC ID 4587849781, 637 clinicians

Bandb Eye Care LLCGroup PAC ID 5991116808, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cory.boudreaux@uprisedirect.com

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

• B&B Eye Care LLC

  dba Shenandoah Eye Clinic

  • Optometrist
  • Baton Rouge, LA
  • NPI 1720694268
  Medicare reassignment Care Compare group NPD Authorized official
• Focal Point Eye Care

  • Optometrist
  • Baton Rouge, LA
  • NPI 1053890822
  Medicare reassignment NPD Authorized official
• Our Lady of the Lake Physician Group LLC

  • Internal Medicine Physician
  • Baton Rouge, LA
  • NPI 1033494943
  Medicare reassignment Care Compare group NPD
• St Francis Medical Group LLC

  • Internal Medicine Physician
  • Monroe, LA
  • NPI 1134405087
  Medicare reassignment NPD
• Williamson Eye Center

  • Ophthalmology Physician
  • Gonzales, LA
  • NPI 1699812909

  Optometrist

  Medicare reassignment NPD
• Our Lady of the Angels Hospital, Inc.

  dba FMOL Health Our Lady of the Angels

  • General Acute Care Hospital
  • Bogalusa, LA
  • NPI 1912334533
  Medicare reassignment
• Our Lady of the Lake Physician Group LLC

  dba Our Lady of the Lake Children's Health Developmental Center at McMains

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Baton Rouge, LA
  • NPI 1235912502
  NPD
• Wash-St Tammany Reg Medical Center

  dba Bogalusa Medical Center

  • General Acute Care Hospital
  • Bogalusa, LA
  • NPI 1508809088
  NPD
• Williamson Eye Center

  • Ophthalmology Physician
  • New Roads, LA
  • NPI 1154943918
  NPD
• Williamson Eye Center

  • Ophthalmology Physician
  • Saint Francisville, LA
  • NPI 1487495131

  Optometrist

  NPD
• Our Lady of the Lake Assumption Community Hospital

  dba Assumption Community Hospital

  • Rural Health Clinic/Center
  • Napoleonville, LA
  • NPI 1710975545
  NPD (past)
• Our Lady of the Lake Physician Group LLC

  dba OLOL Physician Surgical Specialty

  • Hematology & Oncology Physician
  • Baton Rouge, LA
  • NPI 1184671455
  NPD (past)

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

{
    "created_epoch": "1216944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659571200000",
    "number": "1790940096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2308 S BURNSIDE AVE",
            "city": "GONZALES",
            "state": "LA",
            "postal_code": "707374643",
            "telephone_number": "225-644-7525",
            "fax_number": "225-647-3710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2308 S BURNSIDE AVE",
            "city": "GONZALES",
            "state": "LA",
            "postal_code": "707374643",
            "telephone_number": "225-644-7525",
            "fax_number": "225-647-3710"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "433 Plaza St",
            "address_purpose": "LOCATION",
            "city": "Bogalusa",
            "state": "LA",
            "postal_code": "704273729",
            "country_code": "US",
            "telephone_number": "985-730-6700",
            "fax_number": "985-730-6713",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "214 Clinic Dr",
            "address_purpose": "LOCATION",
            "city": "Donaldsonville",
            "state": "LA",
            "postal_code": "703464309",
            "country_code": "US",
            "telephone_number": "225-765-5500",
            "fax_number": "225-473-4406",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11424 Sullivan Rd",
            "address_2": "Bldg A - Ste C",
            "address_purpose": "LOCATION",
            "city": "Baton Rouge",
            "state": "LA",
            "postal_code": "70818",
            "country_code": "US",
            "telephone_number": "225-765-5500",
            "fax_number": "225-261-7258",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2600 Tower Dr Ste 309",
            "address_purpose": "LOCATION",
            "city": "Monroe",
            "state": "LA",
            "postal_code": "712015783",
            "country_code": "US",
            "telephone_number": "318-966-6575",
            "fax_number": "318-966-6586",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "420 Avenue F",
            "address_purpose": "LOCATION",
            "city": "Bogalusa",
            "state": "LA",
            "postal_code": "704273634",
            "country_code": "US",
            "telephone_number": "985-730-6970",
            "fax_number": "985-730-6363",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "18901 Greenwell Springs Rd",
            "address_purpose": "LOCATION",
            "city": "Greenwell Springs",
            "state": "LA",
            "postal_code": "707394827",
            "country_code": "US",
            "telephone_number": "225-924-9985",
            "fax_number": "225-924-0884",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOUDREAUX",
        "first_name": "CORY",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-25",
        "last_updated": "2022-08-04",
        "certification_date": "2022-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "LA",
            "license": "1563-594T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas Edward Boone Jr., PD
• Pilar T. Borne, LCSW
• Brooke Bridevaux Borskey, PA
• Karen Boseman
• Rushell Bossier
• Donna M Boudreaux, RN
• Meredith Hobgood Boudreaux, AU.D.
• Bryant Louis Bourgeois, DDS
• Jennifer Bourgeois, PHARM D
• Bernard B Brach, MD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2022; 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.