Provider Demographics
NPI:1972735710
Name:JENNIFER TATE BRASSEAUX, OD, LLC
Entity type:Organization
Organization Name:JENNIFER TATE BRASSEAUX, OD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:CLAIRE
Authorized Official - Last Name:TATE-BRASSEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:337-407-2888
Mailing Address - Street 1:138 LAZARO BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-9115
Mailing Address - Country:US
Mailing Address - Phone:337-407-2888
Mailing Address - Fax:337-407-2999
Practice Address - Street 1:138 LAZARO BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-9115
Practice Address - Country:US
Practice Address - Phone:337-407-2888
Practice Address - Fax:337-407-2999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1542-573T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1021369Medicaid
3A337Medicare PIN