MEDICARE: DR. JENAYE MARIE DEROCHE OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1879-814AT	LA

General Provider Information

NPI Number	:	1427536937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENAYE MARIE DEROCHE OD

Provider Business Mailing Address
First Line	:	425 SAINT MARY ST
Second Line	:
City	:	THIBODAUX
State	:	LA
Zip	:	70301-2641
Country	:	US
Telephone Number	:	985-447-2393
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 SAINT MARY ST
Second Line	:
City	:	THIBODAUX
State	:	LA
Zip	:	70301-2641
Country	:	US
Telephone Number	:	985-447-2393
Fax Number	:	985-262-7095

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2018
Last Update Date	:	09/25/2023

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