Individual
MICHAEL BRADFORD JELKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2421 CHURCH ST, ZACHARY, LA 70791-2710
(225) 654-1061
(225) 654-0791
Mailing address
2421 CHURCH ST, ZACHARY, LA 70791-2710
(225) 654-1061
(225) 654-0791
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1871-806AT
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1871-806AT
LA OPTOMETRY LICENSE
LA
Enumeration date
07/23/2018
Last updated
03/27/2020
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