Healthcare Provider Details

I. General information

NPI: 1700846581
Provider Name (Legal Business Name): C.J. POLLET O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: CLEMENT J POLLET O.D.

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 03/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3421 HIGHWAY 190
MANDEVILLE LA
70471-3101
US

IV. Provider business mailing address

948 CHUKA CT
MANDEVILLE LA
70471-1508
US

V. Phone/Fax

Practice location:
  • Phone: 985-626-8744
  • Fax: 985-626-5244
Mailing address:
  • Phone: 985-626-8744
  • Fax: 985-626-5244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number986-117T
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number986-117T
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: