Provider Demographics
NPI:1760451116
Name:BEAULIEU, ALAN D (OD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:D
Last Name:BEAULIEU
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 1:336 MAIN ST
Mailing Address - Street 2:WAKEFIELD EYE ASSOCIATES
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-5013
Mailing Address - Country:US
Mailing Address - Phone:781-245-6667
Mailing Address - Fax:781-245-8011
Practice Address - Street 1:336 MAIN ST
Practice Address - Street 2:WAKEFIELD EYE ASSOCIATES
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-5013
Practice Address - Country:US
Practice Address - Phone:781-245-6667
Practice Address - Fax:781-245-8011
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3489152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0356034Medicaid
MA0356034Medicaid