Provider Demographics
NPI:1528570702
Name:LEDUC, MICHAEL JOSEF (ABOC NCLEC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOSEF
Last Name:LEDUC
Suffix:
Gender:M
Credentials:ABOC NCLEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 HOME ST APT 1
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-5315
Mailing Address - Country:US
Mailing Address - Phone:508-642-3313
Mailing Address - Fax:508-558-4791
Practice Address - Street 1:73 HOME ST APT 1
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-5315
Practice Address - Country:US
Practice Address - Phone:508-642-3313
Practice Address - Fax:508-558-4791
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-28
Last Update Date:2017-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6234156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician