Provider Demographics
NPI:1194091710
Name:C J POLLET, O.D., INC
Entity type:Organization
Organization Name:C J POLLET, O.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:C J
Authorized Official - Middle Name:
Authorized Official - Last Name:POLLET
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:985-626-8744
Mailing Address - Street 1:3421 HIGHWAY 190
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-3101
Mailing Address - Country:US
Mailing Address - Phone:985-626-8744
Mailing Address - Fax:985-626-5244
Practice Address - Street 1:3421 HIGHWAY 190
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3101
Practice Address - Country:US
Practice Address - Phone:985-626-8744
Practice Address - Fax:985-626-5244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-28
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA986-117T261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1382965Medicaid
T19443OtherUPIN
LA56962Medicare PIN