1639165186 NPI number — ROBERT PAUL DUQUETTE OPTOMETRIST

Table of content: ROBERT PAUL DUQUETTE OPTOMETRIST (NPI 1639165186)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639165186 NPI number — ROBERT PAUL DUQUETTE OPTOMETRIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUQUETTE
Provider First Name:
ROBERT
Provider Middle Name:
PAUL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OPTOMETRIST
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639165186
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1162 GRAND ARMY HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SWANSEA
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02777-4224
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-676-3036
Provider Business Mailing Address Fax Number:
508-676-3036

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1162 GRAND ARMY HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SWANSEA
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02777-4224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-676-3036
Provider Business Practice Location Address Fax Number:
508-676-3036
Provider Enumeration Date:
09/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2512 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152WC0802X , with the licence number: 2512 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WL0500X , with the licence number: 2512 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 401194 . This is a "RI BLUE CHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: RD00407 . This is a "RI WELFARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 152075 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 201004 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 72397 . This is a "RI BLUE CROSS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: DOC19815 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000024776 . This is a "BOSTON MEDICAL CENTER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0327875 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0459020001 . This is a "DMERC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 76499 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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