Healthcare Provider Details

I. General information

NPI: 1639165186
Provider Name (Legal Business Name): ROBERT PAUL DUQUETTE OPTOMETRIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 09/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1162 GRAND ARMY HWY
SWANSEA MA
02777-4224
US

IV. Provider business mailing address

1162 GRAND ARMY HWY
SWANSEA MA
02777-4224
US

V. Phone/Fax

Practice location:
  • Phone: 508-676-3036
  • Fax: 508-676-3036
Mailing address:
  • Phone: 508-676-3036
  • Fax: 508-676-3036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2512
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number2512
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number2512
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: