Provider Demographics
NPI:1578718623
Name:PERREAULT OPTICIANS
Entity Type:Organization
Organization Name:PERREAULT OPTICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:SIMEON
Authorized Official - Last Name:FORGUES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:978-632-7889
Mailing Address - Street 1:50 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-2601
Mailing Address - Country:US
Mailing Address - Phone:978-632-7889
Mailing Address - Fax:978-632-7889
Practice Address - Street 1:50 MAIN ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-2601
Practice Address - Country:US
Practice Address - Phone:978-632-7889
Practice Address - Fax:978-632-7889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1489332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies