Provider Demographics
NPI:1255127585
Name:MATHIEU, BRENDA-LEE
Entity type:Individual
Prefix:
First Name:BRENDA-LEE
Middle Name:
Last Name:MATHIEU
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 IRVING AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:MA
Mailing Address - Zip Code:02726-2326
Mailing Address - Country:US
Mailing Address - Phone:508-642-2672
Mailing Address - Fax:
Practice Address - Street 1:285 IRVING AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:MA
Practice Address - Zip Code:02726-2326
Practice Address - Country:US
Practice Address - Phone:508-642-2672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADOP6812156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician