Provider Demographics
NPI:1184686420
Name:PROUET, PAUL ETIENNE JR (OD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ETIENNE
Last Name:PROUET
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5554 JACQUELYN CT
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-1047
Mailing Address - Country:US
Mailing Address - Phone:504-782-2990
Mailing Address - Fax:
Practice Address - Street 1:400 WILLIAMS BLVD
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70062-7632
Practice Address - Country:US
Practice Address - Phone:504-461-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1274-431T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1560677Medicaid
LAU80606Medicare UPIN
LA4B248Medicare PIN