Provider Demographics
NPI:1285875302
Name:VISION EXPRESS, LLC
Entity type:Organization
Organization Name:VISION EXPRESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOUDREAUX
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:337-988-6442
Mailing Address - Street 1:3810 AMBASSADOR CAFFERY PKWY
Mailing Address - Street 2:SUITE 700
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-5259
Mailing Address - Country:US
Mailing Address - Phone:337-988-6442
Mailing Address - Fax:
Practice Address - Street 1:3810 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:SUITE 700
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-5259
Practice Address - Country:US
Practice Address - Phone:337-988-6442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier