Provider Demographics
NPI:1598852089
Name:LEGE, TRICIA H (OD)
Entity Type:Individual
Prefix:DR
First Name:TRICIA
Middle Name:H
Last Name:LEGE
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 1:204 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
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1261-415T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA11349745OtherCAQH
LA1544043Medicaid
LA4B236Medicare PIN
LA11349745OtherCAQH