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General NPI Number Information
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NPI Number | 1356529424
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Entity Type | Organization
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Legal Business Name | WAKEFIELD EYE ASSOCIATES
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Dates
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Enumeration Date | 01/31/2008
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 336 MAIN ST
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City | WAKEFIELD
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State | MA
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Zip | 01880-5013
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Country | US
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Telephone | 781-245-6667
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Fax | 781-245-8011
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Provider Business Mailing Address
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Address Line | 336 MAIN ST
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City | WAKEFIELD
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State | MA
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Zip | 01880-5013
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Country | US
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Telephone | 781-245-6667
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Fax | 781-245-8011
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | ALAN D BEAULIEU
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Credential | OD
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Telephone | 781-245-6667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 3489
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License Number State | MA
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