Physician Compare National (NPI:1679601629)

HEALTHCARE PROVIDER: JEFFREY DAVID BOUDREAUX O.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1679601629
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8729273057
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20101112000467
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BOUDREAUX
	Individual professional last name
Provider First Name	JEFFREY
	Individual professional first name
Provider Middle Name	D
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	ILLINOIS COLLEGE OF OPTOMETRY AT CHICAGO
	Individual professional's medical school
Graduation Year	1997
	Individual professional's medical school graduation year
Primary Specialty	OPTOMETRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	3810 AMBASSADOR CAFFERY PKWY
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 700
	Group Practice or individual's line 2 address
City	LAFAYETTE
	Group Practice or individual's city
State	LA
	Group Practice or individual's state
Zip Code	705035266
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y