Provider Demographics
NPI:1861281024
Name:BOUFFARD, MEGAN A (ABOC NCLEC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:A
Last Name:BOUFFARD
Suffix:
Gender:F
Credentials:ABOC NCLEC
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:A
Other - Last Name:TYLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ABOC NCLEC
Mailing Address - Street 1:81 JOHNSON RD # A
Mailing Address - Street 2:
Mailing Address - City:BOLTON
Mailing Address - State:CT
Mailing Address - Zip Code:06043-7616
Mailing Address - Country:US
Mailing Address - Phone:860-830-7192
Mailing Address - Fax:
Practice Address - Street 1:81 JOHNSON RD # A
Practice Address - Street 2:
Practice Address - City:BOLTON
Practice Address - State:CT
Practice Address - Zip Code:06043-7616
Practice Address - Country:US
Practice Address - Phone:860-830-7192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1829156FC0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens Fitter