Provider Demographics
NPI:1518936186
Name:LOUIE, JEANNE W (OD)
Entity Type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:W
Last Name:LOUIE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:477 N EL CAMINO REAL
Mailing Address - Street 2:C-308
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1328
Mailing Address - Country:US
Mailing Address - Phone:760-942-9225
Mailing Address - Fax:760-942-9343
Practice Address - Street 1:477 N EL CAMINO REAL
Practice Address - Street 2:C-308
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1328
Practice Address - Country:US
Practice Address - Phone:760-942-9225
Practice Address - Fax:760-942-9343
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12226T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU97461Medicare UPIN