Provider Demographics
NPI:1760140933
Name:LABRANCHE, JEFFREY JAMES (ABOC, NCLEC)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:JAMES
Last Name:LABRANCHE
Suffix:
Gender:M
Credentials:ABOC, NCLEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 LAKE CT
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-2738
Mailing Address - Country:US
Mailing Address - Phone:636-493-9190
Mailing Address - Fax:
Practice Address - Street 1:6100 RONALD REAGAN DR
Practice Address - Street 2:
Practice Address - City:LAKE SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-2660
Practice Address - Country:US
Practice Address - Phone:636-625-2143
Practice Address - Fax:636-625-2148
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician