Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | OPT554 | ME |
NPI | 1104956143 |
---|---|
Provider Name | Dr. Douglas Kent Gauvreau |
First Address | Westbrook, ME 04092-4808 |
Second Address | Westbrook, ME 04092-4808 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 23/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000378 | BC & BS (01) | ME |
0468580001 | MEDICARE DMEPOS (01) | ME |
107830099 | (05) | ME |
410032606 | RAILROAD MEDICARE (01) | ME |
T31693 | (02) | ME |