Provider Demographics
NPI:1144391442
Name:COMEAUX, KEITH M (OD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:M
Last Name:COMEAUX
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 1:1301 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
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA1081050T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LALA1081OtherMORGAN CITY BLUE CROSS
LA1919519Medicaid
LA1919519Medicaid
LA497817630Medicare PIN
LA4085840001Medicare NSC
LA4085840002Medicare NSC
LA497817616Medicare PIN