Provider Demographics
NPI:1336241322
Name:LOUIS, JEAN CLAUDY (OD)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:CLAUDY
Last Name:LOUIS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-3003
Mailing Address - Country:US
Mailing Address - Phone:917-513-6659
Mailing Address - Fax:
Practice Address - Street 1:883 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-4677
Practice Address - Country:US
Practice Address - Phone:732-549-1373
Practice Address - Fax:732-906-3634
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332H00000X
NYTUV006554-1152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02290311Medicaid
NY02290311Medicaid
NYV00163Medicare UPIN