Provider Demographics
NPI:1457760530
Name:AUTHEMENT, MASON JAMES (OD)
Entity type:Individual
Prefix:DR
First Name:MASON
Middle Name:JAMES
Last Name:AUTHEMENT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 ARAGON RD
Mailing Address - Street 2:
Mailing Address - City:MONTEGUT
Mailing Address - State:LA
Mailing Address - Zip Code:70377-3313
Mailing Address - Country:US
Mailing Address - Phone:985-804-2138
Mailing Address - Fax:
Practice Address - Street 1:1552 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-2404
Practice Address - Country:US
Practice Address - Phone:985-274-0413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1788-722T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist