Provider Demographics
NPI:1881884245
Name:TATE-BRASSEAUX, JENNIFER CLAIRE (OD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:CLAIRE
Last Name:TATE-BRASSEAUX
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:138 LAZARO BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-9115
Mailing Address - Country:US
Mailing Address - Phone:337-407-2888
Mailing Address - Fax:337-407-2999
Practice Address - Street 1:138 LAZARO BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-9115
Practice Address - Country:US
Practice Address - Phone:337-407-2888
Practice Address - Fax:337-407-2999
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1542-573AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1021369Medicaid
LA3A377OtherMEDICARE PTAN