Provider Demographics
NPI:1336241322
Name:LOUIS, JEAN CLAUDY (OD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:CLAUDY
Last Name:LOUIS
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 1:2922 AVENUE L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4639
Mailing Address - Country:US
Mailing Address - Phone:718-513-6911
Mailing Address - Fax:718-513-6912
Practice Address - Street 1:2618 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-5012
Practice Address - Country:US
Practice Address - Phone:212-666-2615
Practice Address - Fax:212-400-6255
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006554-1152WX0102X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02290311Medicaid
NY02290311Medicaid
NYV00163Medicare UPIN