MEDICARE: DR. BRIAN PAUL COURTEMANCHE O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	002567	CT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	410047532	OTHER	CT	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386673648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN PAUL COURTEMANCHE O.D.

Provider Business Mailing Address
First Line	:	230 NORTH MAIN ST.
Second Line	:
City	:	MANCHESTER
State	:	CT
Zip	:	06042-2004
Country	:	US
Telephone Number	:	860-646-4083
Fax Number	:	860-647-1733

Provider Business Practice Location Address
First Line	:	230 N MAIN ST
Second Line	:
City	:	MANCHESTER
State	:	CT
Zip	:	06042-2004
Country	:	US
Telephone Number	:	860-646-4083
Fax Number	:	860-647-1733

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	10/26/2007

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