Provider Demographics
NPI:1255628392
Name:SMITH-BOUDREAUX, CLAUDETTE (OD)
Entity type:Individual
Prefix:DR
First Name:CLAUDETTE
Middle Name:
Last Name:SMITH-BOUDREAUX
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 1:315 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CHURCH POINT
Mailing Address - State:LA
Mailing Address - Zip Code:70525-2914
Mailing Address - Country:US
Mailing Address - Phone:337-684-0018
Mailing Address - Fax:337-684-0715
Practice Address - Street 1:315 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CHURCH POINT
Practice Address - State:LA
Practice Address - Zip Code:70525-2914
Practice Address - Country:US
Practice Address - Phone:337-684-0018
Practice Address - Fax:337-684-0715
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7721T152W00000X
LA1626-659T152W00000X
LA1626-659AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2308203Medicaid