Provider Demographics
NPI:1679656011
Name:MICHAUD, LORI B (OD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:B
Last Name:MICHAUD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 FAUNCE CORNER RD
Mailing Address - Street 2:110
Mailing Address - City:N DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-1278
Mailing Address - Country:US
Mailing Address - Phone:508-717-0270
Mailing Address - Fax:508-995-3060
Practice Address - Street 1:500 FAUNCE CORNER RD
Practice Address - Street 2:110
Practice Address - City:N DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-1278
Practice Address - Country:US
Practice Address - Phone:508-717-0270
Practice Address - Fax:508-995-3060
Is Sole Proprietor?:No
Enumeration Date:2006-10-21
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA 4292152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAU91473Medicare UPIN
MAW17439Medicare ID - Type UnspecifiedMEDICARE