Mitchell Neil Broussard O.D.

NPI 1013904473 - Optometrist - 152W00000X

NPI Details
NPI 1013904473
Gender Male
Enumeration Date 09/30/2005
Last Updated 02/20/2012
Entity Type Individual
Active Over 11 years ago
Practice Location
5725 JOHNSTON ST
SUITE 2314
LAFAYETTE LA, 70503-5315, US
Phone (337) 984-2410
Fax (337) 984-2416
Business Location
5725 JOHNSTON ST
SUITE 2314
LAFAYETTE LA, 70503-5315, US
Phone (337) 984-2410
Fax (337) 984-2416
Toxanomy
Taxonomy Code 152W00000X
License State Louisiana
License Number 1105-195T
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According to our database, Dr. Mitchell Neil Broussard O.D. NPI is 1013904473, taxonomy code is 152W00000X and license number is 1105-195T, license state is located at Louisiana. Mitchell Neil Broussard O.D. physically located at 5725 Johnston St, Lafayette LA, 70503-5315. NPI Number Mitchell Neil Broussard O.D. has the Individual type.

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1013904473 NPI number is provided on an as is basis without warranty of any kind. 1013904473 is maintained by the National Plan & Provider Enumeration System. The contents of Mitchell Neil Broussard O.D. are for informational purposes only.