NPIMap

Organization Active NPI

Bluebonnet Vision

  • Optometrist
  • Baton Rouge, LA
National Provider Identifier
1801960919
Registry record updated Oct 15, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
BLUEBONNET VISION
Practice address
4451 Bluebonnet Blvd
Suite C
Baton Rouge, LA 70809-9639
Phone
(225) 291-2414
Fax
(225) 291-2418
NPI assigned
Nov 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2009

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

Authorized official

Name
Dr. Jeffery Dibenedetto, O.D.
Title
Owner/Ceo
Phone
(225) 291-2414

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X Primary
Corneal and Contact Management OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152WC0802X
Pediatric OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152WP0200X
Eyewear Supplier 332H00000X

Addresses

Primary practice location

4451 Bluebonnet Blvd
Suite C
Baton Rouge, LA 70809-9639

Mailing address

4451 Bluebonnet Blvd
Suite C
Baton Rouge, LA 70809-9639
Phone (225) 291-2414

Other identifiers 2

IdentifierTypeStateIssuer
1013949833OtherLANPI
1255360525OtherLANPI

Other names 1

  • Bluebonnet Vision LLC Former legal business name

National Provider Directory

National Provider Directory

Locations

4451 Bluebonnet Blvd
Ste C
Baton Rouge, LA 70809
Phone (225) 291-2414

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1255564800000",
    "number": "1801960919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4451 BLUEBONNET BLVD",
            "address_2": "SUITE C",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708099639",
            "telephone_number": "225-291-2414",
            "fax_number": "225-291-2418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4451 BLUEBONNET BLVD",
            "address_2": "SUITE C",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708099639",
            "telephone_number": "225-291-2414",
            "fax_number": "225-291-2418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUEBONNET VISION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-20",
        "last_updated": "2009-10-15",
        "status": "A",
        "authorized_official_last_name": "DIBENEDETTO",
        "authorized_official_first_name": "JEFFERY",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "225-291-2414",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1013949833",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1255360525",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bluebonnet Vision LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Baton Rouge, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 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.