Provider Demographics
NPI:1376942870
Name:TRICIA H LEGE OD LLC
Entity Type:Organization
Organization Name:TRICIA H LEGE OD LLC
Other - Org Name:DR. TRICIA H. LEGE, O.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:H
Authorized Official - Last Name:LEGE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:337-740-2020
Mailing Address - Street 1:204 N SAINT CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70510-5106
Mailing Address - Country:US
Mailing Address - Phone:337-740-2020
Mailing Address - Fax:337-740-2022
Practice Address - Street 1:204 N SAINT CHARLES ST
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-5106
Practice Address - Country:US
Practice Address - Phone:337-740-2020
Practice Address - Fax:337-740-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1261-415T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA11349745OtherCAQH
LA1544043Medicaid
MAU70746Medicare UPIN
LA11349745OtherCAQH