NPIMap

Organization Active NPI

Mary C. Beaulieu, OD

  • Optometrist
  • Waterford, CT
National Provider Identifier
1316083215
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2212 Issued in CT
Legal business name
MARY C. BEAULIEU, OD
Practice address
125 Boston Post Rd
Waterford, CT 06385-2812
Phone
(860) 442-5058
Fax
(860) 443-4118
NPI assigned
Jan 29, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Mary C Beaulieu, O.D.NPI 1528126117
Title
Owner
Phone
(860) 442-5058

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2212 CT Primary

Addresses

Primary practice location

125 Boston Post Rd
Waterford, CT 06385-2812

Mailing address

125 Boston Post Rd
Waterford, CT 06385-2812
Phone (860) 442-5058

National Provider Directory

National Provider Directory

Locations

125 Boston Post Rd
Waterford, CT 06385
Phone (860) 442-5058

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1316083215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 BOSTON POST RD",
            "city": "WATERFORD",
            "state": "CT",
            "postal_code": "063852812",
            "telephone_number": "860-442-5058",
            "fax_number": "860-443-4118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 BOSTON POST RD",
            "city": "WATERFORD",
            "state": "CT",
            "postal_code": "063852812",
            "telephone_number": "860-442-5058",
            "fax_number": "860-443-4118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY C. BEAULIEU, OD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BEAULIEU",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-442-5058",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CT",
            "license": "2212",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.