Organization
PROFESSIONAL EYECARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY C BEAULIEU O.D. (PRESIDENT/OWNER)
(860) 442-5058
Entity
Organization
Contact information
Practice address
131 BOSTON POST RD, SUITE 4, WATERFORD, CT 06385-2839
(860) 442-5058
(860) 443-4118
Mailing address
131 BOSTON POST ROAD, SUITE 4, WATERFORD, CT 06385
(860) 442-5058
(860) 443-4118
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2212
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004092277
—
CT
Enumeration date
06/11/2009
Last updated
06/11/2009
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