Provider Demographics
NPI:1194792648
Name:DOUCETTE, CATHLEEN LANIGAN (OD)
Entity type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:LANIGAN
Last Name:DOUCETTE
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 1:27 WINDWARD DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-3362
Mailing Address - Country:US
Mailing Address - Phone:978-499-0644
Mailing Address - Fax:
Practice Address - Street 1:291 MAIN ST
Practice Address - Street 2:
Practice Address - City:GROVELAND
Practice Address - State:MA
Practice Address - Zip Code:01834-1234
Practice Address - Country:US
Practice Address - Phone:978-374-8991
Practice Address - Fax:978-373-7852
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4046152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0312762Medicaid
MAW16404OtherBC/BS
MAU82668Medicare UPIN
MADOW17332Medicare ID - Type Unspecified