Provider Demographics
NPI:1902199334
Name:BEAUPRE, NICOLAS MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:NICOLAS
Middle Name:MICHAEL
Last Name:BEAUPRE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60160
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0160
Mailing Address - Country:US
Mailing Address - Phone:704-365-0555
Mailing Address - Fax:704-367-8122
Practice Address - Street 1:135 S SHARON AMITY RD STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211
Practice Address - Country:US
Practice Address - Phone:704-365-0555
Practice Address - Fax:704-367-8120
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2547152W00000X
NYTUV07756-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist