Bourg, Otis J
Bourg, Otis J is an sole proprietor health care provider with primary practice located at 832 Belanger St , Houma LA 70360-4408. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Bourg, Otis J can be contacted via phone (985) 872-1494.Contact Information
Primary practice address
832 Belanger St
Houma LA 70360-4408
Phone: (985) 872-1494
Fax: (985) 580-4422
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | LA666265T | Louisiana |
Profile Details
| NPI number | 1114009313 |
|---|---|
| LBN Legal business name | Bourg, Otis J |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Oct 19th, 2006 |
| Last updated | Mar 11th, 2009 - about 15 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1114009313 | NPPES |
| Louisiana | MEDICAID | 1094196 | |
| Louisiana | Other | 110894 | |
| Louisiana | Other | 06110 | |
| Louisiana | Other | BO908019 |
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