Provider Demographics
NPI:1922397009
Name:D. E. BETTENCOURT, O.D., LLC.
Entity Type:Organization
Organization Name:D. E. BETTENCOURT, O.D., LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:BETTENCOURT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:508-854-0595
Mailing Address - Street 1:360 W BOYLSTON ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:WEST BOYLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01583-2365
Mailing Address - Country:US
Mailing Address - Phone:508-854-0595
Mailing Address - Fax:
Practice Address - Street 1:360 W BOYLSTON ST
Practice Address - Street 2:SUITE 106
Practice Address - City:WEST BOYLSTON
Practice Address - State:MA
Practice Address - Zip Code:01583-2365
Practice Address - Country:US
Practice Address - Phone:508-854-0595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3219152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty