Provider Demographics
NPI:1356529424
Name:WAKEFIELD EYE ASSOCIATES
Entity type:Organization
Organization Name:WAKEFIELD EYE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BEAULIEU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:781-245-6667
Mailing Address - Street 1:336 MAIN ST
Mailing Address - Street 2:
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:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3489332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0356034Medicaid
MA0356034Medicaid