# JENNIFER TATE BRASSEAUX, OD, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972735710
- **Authorized official:** DR. JENNIFER CLAIRE TATE-BRASSEAUX O.D (OWNER)
- **Authorized official phone:** (337) 407-2888

## Contact information

- **Practice address:** 138 LAZARO BLVD, SUITE A, OPELOUSAS, LA 70570-9115
- **Practice address phone:** (337) 407-2888
- **Practice address fax:** (337) 407-2999
- **Mailing address:** 138 LAZARO BLVD, SUITE B, OPELOUSAS, LA 70570-9115
- **Mailing address phone:** (337) 407-2888
- **Mailing address fax:** (337) 407-2999

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | 1542-573T | LA | Yes |

## Other

- **Enumeration date:** 08/12/2009
- **Last updated:** 10/12/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1021369 | — | LA |