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General NPI Number Information
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NPI Number | 1457189383
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Entity Type | Individual
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Provider Name | MATTHEW E BEAULIEU OD
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Gender | Male
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Dates
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Enumeration Date | 07/23/2024
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Last Update Date | 02/28/2025
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Provider Practice Location Address
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Address Line | 14 MOUNTAIN LEDGE
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City | WILTON
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State | NY
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Zip | 12831-1993
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Country | US
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Telephone | 518-450-1080
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Fax | 518-478-8500
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Provider Business Mailing Address
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Address Line | 14 MOUNTAIN LEDGE
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City | WILTON
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State | NY
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Zip | 12831-1993
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Country | US
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Telephone | 518-450-1080
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Fax | 518-478-8500
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 010027
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License Number State | NY
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