Provider Demographics
NPI:1114457140
Name:KEITH M. COMEAUX, O.D. APOC
Entity Type:Organization
Organization Name:KEITH M. COMEAUX, O.D. APOC
Other - Org Name:ST. MARY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:STELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-385-5744
Mailing Address - Street 1:1301 VICTOR II BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70380-1454
Mailing Address - Country:US
Mailing Address - Phone:985-385-5744
Mailing Address - Fax:985-384-6194
Practice Address - Street 1:1301 VICTOR II BLVD STE B
Practice Address - Street 2:
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-1454
Practice Address - Country:US
Practice Address - Phone:985-385-5744
Practice Address - Fax:985-384-6194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1081-050AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1919519Medicaid