Provider Demographics
NPI:1598311193
Name:AGNEW, LAUREN (OD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:AGNEW
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-4814
Mailing Address - Country:US
Mailing Address - Phone:985-720-7120
Mailing Address - Fax:
Practice Address - Street 1:3601 HIGHWAY 190 STE B
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-8632
Practice Address - Country:US
Practice Address - Phone:985-624-3314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-11
Last Update Date:2019-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1896-832AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist