Provider Demographics
NPI:1134100357
Name:GOULET, ANNE-LOUISE (OD)
Entity Type:Individual
Prefix:DR
First Name:ANNE-LOUISE
Middle Name:
Last Name:GOULET
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 1:75 LEIGHTON RD
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-2207
Mailing Address - Country:US
Mailing Address - Phone:207-775-2102
Mailing Address - Fax:207-772-2097
Practice Address - Street 1:75 LEIGHTON RD
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-2207
Practice Address - Country:US
Practice Address - Phone:207-775-2102
Practice Address - Fax:207-772-2097
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT781152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
035291OtherANTHEM
ME134530000Medicaid
0005879077OtherAETNA
ME134530000Medicaid
U40140Medicare UPIN
MEMM4720Medicare PIN