Provider Demographics
NPI:1295831196
Name:BEAUDET, ROGER (OD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:
Last Name:BEAUDET
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 1:501 GREAT RD STE 107
Mailing Address - Street 2:
Mailing Address - City:NORTH SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02896-6833
Mailing Address - Country:US
Mailing Address - Phone:401-769-6252
Mailing Address - Fax:401-769-2460
Practice Address - Street 1:501 GREAT RD STE 107
Practice Address - Street 2:
Practice Address - City:NORTH SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02896-6833
Practice Address - Country:US
Practice Address - Phone:401-769-6252
Practice Address - Fax:401-769-2460
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI333TA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9009721Medicaid
RI419009721Medicare PIN