Provider Demographics
NPI:1063576809
Name:MIGNAULT, DAVID PAUL (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PAUL
Last Name:MIGNAULT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906-3143
Mailing Address - Country:US
Mailing Address - Phone:781-233-9570
Mailing Address - Fax:
Practice Address - Street 1:335 MAIN ST
Practice Address - Street 2:
Practice Address - City:SAUGUS
Practice Address - State:MA
Practice Address - Zip Code:01906
Practice Address - Country:US
Practice Address - Phone:928-857-6320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3689152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0392332Medicaid
MAW15988Medicare PIN