Provider Demographics
NPI:1619906591
Name:ARSENAULT, PHILIP MICHAEL (OD)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:MICHAEL
Last Name:ARSENAULT
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 1:71 THAYER AVE
Mailing Address - Street 2:
Mailing Address - City:WEST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02379-1328
Mailing Address - Country:US
Mailing Address - Phone:508-559-8764
Mailing Address - Fax:
Practice Address - Street 1:250 GRANITE ST
Practice Address - Street 2:SUITE NUMBER 2069
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-2804
Practice Address - Country:US
Practice Address - Phone:781-849-9944
Practice Address - Fax:781-848-1023
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA4347152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0034365OtherNEIGHBORHOOD HEALTH PLAN
MA0324981Medicaid
MAMA4347OtherEYEMED VISION PLAN
MA7313791OtherCIGNA
MAW16387OtherBLUE CROSS BLUE SHIELD
MA3500892OtherAETNA
MA469480OtherTUFTS HEALTH PLAN
MA5495618OtherFIRST HEALTH
MAAA10463OtherHARVARD PILGRIM
MA5495618OtherFIRST HEALTH
MA3500892OtherAETNA