Provider Demographics
NPI:1033602230
Name:GOBEILLE, MICAELA RAE (OD)
Entity Type:Individual
Prefix:DR
First Name:MICAELA
Middle Name:RAE
Last Name:GOBEILLE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 LINWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-5207
Mailing Address - Country:US
Mailing Address - Phone:401-714-2574
Mailing Address - Fax:
Practice Address - Street 1:163 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06415-1022
Practice Address - Country:US
Practice Address - Phone:860-537-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5455152W00000X
CT3151152WL0500X
NYPENDING152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation