Provider Demographics
NPI:1639165186
Name:DUQUETTE, ROBERT PAUL (OPTOMETRIST)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:PAUL
Last Name:DUQUETTE
Suffix:
Gender:M
Credentials:OPTOMETRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1162 GRAND ARMY HWY
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02777-4224
Mailing Address - Country:US
Mailing Address - Phone:508-676-3036
Mailing Address - Fax:508-676-3036
Practice Address - Street 1:1162 GRAND ARMY HWY
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:MA
Practice Address - Zip Code:02777-4224
Practice Address - Country:US
Practice Address - Phone:508-676-3036
Practice Address - Fax:508-676-3036
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2512152W00000X, 152WC0802X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI401194OtherRI BLUE CHIP
MARD00407OtherRI WELFARE
MA152075OtherHARVARD PILGRIM
MA201004OtherUNITED HEALTHCARE
MA72397OtherRI BLUE CROSS
MADOC19815OtherNEIGHBORHOOD HEALTH PLAN
MA000000024776OtherBOSTON MEDICAL CENTER
MA0327875Medicaid
MA0459020001OtherDMERC
MA76499OtherTUFTS
MA72397OtherRI BLUE CROSS
MA000000024776OtherBOSTON MEDICAL CENTER