Provider Demographics
NPI:1760451116
Name:BEAULIEU, ALAN D (OD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:D
Last Name:BEAULIEU
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:195 ROOSEVELT TRL
Mailing Address - Street 2:
Mailing Address - City:CASCO
Mailing Address - State:ME
Mailing Address - Zip Code:04015-4215
Mailing Address - Country:US
Mailing Address - Phone:207-655-2020
Mailing Address - Fax:207-209-5502
Practice Address - Street 1:5 LUMBERYARD DR UNIT 2
Practice Address - Street 2:
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009-4167
Practice Address - Country:US
Practice Address - Phone:207-655-2020
Practice Address - Fax:207-209-5502
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3489152W00000X
ME1075152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0356034Medicaid
MA0356034Medicaid