Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 1876-811AT | LA |
NPI | 1003393240 |
---|---|
Provider Name | Katherine J. Fontenot |
First Address | Lake Charles, LA 70605-5362 |
Second Address | Lake Charles, LA 70605-5362 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2018 |
Last Update Date | 20/07/2018 |