Provider Demographics
NPI:1124222336
Name:DAIGNEAULT, CYNTHIA LOUISE (ABOC NCLEC RDO FNAO)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:LOUISE
Last Name:DAIGNEAULT
Suffix:
Gender:F
Credentials:ABOC NCLEC RDO FNAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 FOREST GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:WRENTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02093-1006
Mailing Address - Country:US
Mailing Address - Phone:508-384-3688
Mailing Address - Fax:508-384-3688
Practice Address - Street 1:285 FOREST GROVE AVE
Practice Address - Street 2:
Practice Address - City:WRENTHAM
Practice Address - State:MA
Practice Address - Zip Code:02093-1006
Practice Address - Country:US
Practice Address - Phone:508-384-3688
Practice Address - Fax:508-384-3688
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5810156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0720194Medicaid