Provider Demographics
NPI:1063442713
Name:DUQUETTE, LORI ANN (OD)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:ANN
Last Name:DUQUETTE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 POUND HILL RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NORTH SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02896-9358
Mailing Address - Country:US
Mailing Address - Phone:401-769-6323
Mailing Address - Fax:401-769-9202
Practice Address - Street 1:621 POUND HILL RD
Practice Address - Street 2:SUITE 104
Practice Address - City:NORTH SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02896-9358
Practice Address - Country:US
Practice Address - Phone:401-769-6323
Practice Address - Fax:401-769-9202
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTA00475152W00000X
RIODTG00516152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7006950Medicaid
RI7006950Medicaid
RI709006298Medicare PIN