Provider Demographics
NPI:1477662674
Name:TRUDEAU, JAMES A III
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:TRUDEAU
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 E CHEROKEE AVE
Mailing Address - Street 2:
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955-5035
Mailing Address - Country:US
Mailing Address - Phone:918-775-4524
Mailing Address - Fax:918-775-4992
Practice Address - Street 1:1105 E CHEROKEE AVE
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-5035
Practice Address - Country:US
Practice Address - Phone:918-775-4524
Practice Address - Fax:918-775-4992
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK824152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100764240AMedicaid
OK100764240AMedicaid
OKT40690Medicare UPIN