Healthcare Provider Details

I. General information

NPI: 1760451116
Provider Name (Legal Business Name): ALAN D. BEAULIEU O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 LUMBERYARD DR UNIT 2
BRIDGTON ME
04009-4167
US

IV. Provider business mailing address

195 ROOSEVELT TRL
CASCO ME
04015-4215
US

V. Phone/Fax

Practice location:
  • Phone: 207-655-2020
  • Fax: 207-209-5502
Mailing address:
  • Phone: 207-655-2020
  • Fax: 207-209-5502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3489
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1075
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: