Provider Demographics
NPI:1265460968
Name:DELUGAN, JAMIE ROBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:ROBERT
Last Name:DELUGAN
Suffix:
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 1:340 WOOD RD
Mailing Address - Street 2:SUITE 2020
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-2401
Mailing Address - Country:US
Mailing Address - Phone:781-794-2200
Mailing Address - Fax:781-794-2239
Practice Address - Street 1:340 WOOD RD
Practice Address - Street 2:SUITE 2020
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-2401
Practice Address - Country:US
Practice Address - Phone:781-794-2200
Practice Address - Fax:781-794-2239
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3116152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0391778Medicaid
MA0391778Medicaid
MA440958Medicare ID - Type Unspecified