Healthcare Provider Details

I. General information

NPI: 1457274904
Provider Name (Legal Business Name): JAKELINE YOLANDA CHAVEZ OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W PRIEN LAKE RD STE 400
LAKE CHARLES LA
70601-9124
US

IV. Provider business mailing address

318 ROUSS ST
DERIDDER LA
70634-4126
US

V. Phone/Fax

Practice location:
  • Phone: 337-502-4550
  • Fax:
Mailing address:
  • Phone: 337-401-6609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2092-039AT
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2092-039AT
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: