Provider Demographics
NPI:1942084504
Name:ROULEAU, BEVERLY JO (OPTICIAN)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:JO
Last Name:ROULEAU
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7800 E HAMPDEN AVE UNIT 51
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4862
Mailing Address - Country:US
Mailing Address - Phone:303-755-9880
Mailing Address - Fax:303-338-5994
Practice Address - Street 1:7800 E HAMPDEN AVE UNIT 51
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-4862
Practice Address - Country:US
Practice Address - Phone:303-755-9880
Practice Address - Fax:303-338-5994
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO095713156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician