Provider Demographics
NPI:1144459272
Name:DEBELLEVUE, VALLEE AUGUSTUS II (OD)
Entity type:Individual
Prefix:DR
First Name:VALLEE
Middle Name:AUGUSTUS
Last Name:DEBELLEVUE
Suffix:II
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:72004 KUSTENMACHER RD
Mailing Address - Street 2:
Mailing Address - City:ABITA SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70420-3504
Mailing Address - Country:US
Mailing Address - Phone:985-867-9880
Mailing Address - Fax:985-867-9880
Practice Address - Street 1:72004 KUSTENMACHER RD
Practice Address - Street 2:
Practice Address - City:ABITA SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70420-3504
Practice Address - Country:US
Practice Address - Phone:985-867-9880
Practice Address - Fax:985-867-9880
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-10
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA727390T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA49416Medicare PIN
LAT75524Medicare UPIN