NPIMap

Organization Active NPI

St. Charles Vision Outlet Mandeville, LLC

  • Optometrist
  • Mandeville, LA
National Provider Identifier
1952428005
Registry record updated Jun 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1318453T Issued in LA
Legal business name
ST. CHARLES VISION OUTLET MANDEVILLE, LLC
Practice address
1844 N. Causeway Blvd.
Mandeville, LA 70471
Phone
(985) 626-8103
NPI assigned
Mar 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2014

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

Authorized official

Name
Mrs. Kristy G Roussel
Title
Office Manager
Phone
(985) 626-8103

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X 1318453T LA Primary

Addresses

Primary practice location

1844 N. Causeway Blvd.
Mandeville, LA 70471

Mailing address

1844 N. Causeway Blvd.
Mandeville, LA 70471
Phone (985) 626-8103

Other names 1

  • St. Charles Vision Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402444800000",
    "number": "1952428005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1844 N. CAUSEWAY BLVD.",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "70471",
            "telephone_number": "985-626-8103",
            "fax_number": "985-626-5571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1844 N. CAUSEWAY BLVD.",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "70471",
            "telephone_number": "985-626-8103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. CHARLES VISION OUTLET MANDEVILLE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-23",
        "last_updated": "2014-06-11",
        "status": "A",
        "authorized_official_last_name": "ROUSSEL",
        "authorized_official_first_name": "KRISTY",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "985-626-8103",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "LA",
            "license": "1318453T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Charles Vision",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mandeville, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2014; 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.