| NPI | 1801960919 |
|---|---|
| Former Legal Business Name | BLUEBONNET VISION LLC |
| Entity Type | Organization |
| Authorized Contact | JEFFERY DIBENEDETTO Owner/CEO 225-291-2414 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management |
| 152WP0200X Optometrist Pediatrics | |
| 332H00000X Eyewear Supplier | |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2009-10-15 |