NPI 1013904473

Mitchell Neil Broussard, OD

Practitioner Optometrist Lafayette, LA

Practice location

Address: 5725 Johnston St Suite 2314, Lafayette, LA 70503-5315
Phone: (337) 984-2410
Fax: (337) 984-2416

Registered specialties

Optometrist Primary

Eye and Vision Services Providers Taxonomy 152W00000X Licence 1105-195T (LA)

Other Optometrist providers in Louisiana →

Registry record

NPI: 1013904473
Entity type: Individual
Sex (as registered): Male
NPI issued: 30 Sep 2005
Record last updated: 20 Feb 2012

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.