Provider Demographics
NPI:1679601629
Name:BOUDREAUX, JEFFREY DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:DAVID
Last Name:BOUDREAUX
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9551 ELLIOT RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-7006
Mailing Address - Country:US
Mailing Address - Phone:225-755-7905
Mailing Address - Fax:
Practice Address - Street 1:3810 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:SUITE 700
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-5259
Practice Address - Country:US
Practice Address - Phone:337-988-6442
Practice Address - Fax:337-984-7571
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1233-399T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist