Provider Demographics
NPI:1700846581
Name:POLLET, C.J. (OD)
Entity Type:Individual
Prefix:
First Name:C.J.
Middle Name:
Last Name:POLLET
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:CLEMENT
Other - Middle Name:J
Other - Last Name:POLLET
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:948 CHUKA CT
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-1508
Mailing Address - Country:US
Mailing Address - Phone:985-626-8744
Mailing Address - Fax:985-626-5244
Practice Address - Street 1:3421 HIGHWAY 190
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3101
Practice Address - Country:US
Practice Address - Phone:985-626-8744
Practice Address - Fax:985-626-5244
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA986-117T152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1382965Medicaid
LA1382965Medicaid
47681Medicare PIN