MEDICARE: JACQUELINE A RHEAULT OD

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	0646	NH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	410038181	OTHER		MEDICARE RR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0900169YONH01	OTHER	NH	ANTHEM
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	312992	OTHER	NH	CIGNA

General Provider Information

NPI Number	:	1578564464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE A RHEAULT OD

Provider Business Mailing Address
First Line	:	248 PLEASANT ST
Second Line	:	STE 1600
City	:	CONCORD
State	:	NH
Zip	:	03301-2588
Country	:	US
Telephone Number	:	603-224-2020
Fax Number	:	603-228-0248

Provider Business Practice Location Address
First Line	:	248 PLEASANT ST
Second Line	:	STE 1600
City	:	CONCORD
State	:	NH
Zip	:	03301-2588
Country	:	US
Telephone Number	:	603-224-2020
Fax Number	:	603-228-0248

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

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	04/21/2020

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Directions to “ JACQUELINE A RHEAULT OD” Practice Location

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