1235396755 NPI number — MASHPEE VISION CARE

Table of content: (NPI 1235396755)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235396755 NPI number — MASHPEE VISION CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MASHPEE VISION CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235396755
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
681 FALMOUTH RD
Provider Second Line Business Mailing Address:
UPPER LEVEL
Provider Business Mailing Address City Name:
MASHPEE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02649-3327
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-477-1802
Provider Business Mailing Address Fax Number:
508-539-3713

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
681 FALMOUTH RD
Provider Second Line Business Practice Location Address:
SUITE B12
Provider Business Practice Location Address City Name:
MASHPEE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02649-3327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-477-1802
Provider Business Practice Location Address Fax Number:
508-539-3713
Provider Enumeration Date:
05/21/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GROVE
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
LYNNE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
508-477-1802

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 2864 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 12434 . This is a "152W00000X" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0352446 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 454369 . This is a "152W00000X" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: OP3143 . This is a "152W00000X" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 201700019 . This is a "152W00000X" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2200561 . This is a "152W00000X" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 233717 . This is a "152W00000X" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 000001377 . This is a "152W00000X" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1101851567 . This is a "152W00000X" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1235396755 . This is a "152W00000X" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: S012088 . This is a "152W00000X" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 20838343610 . This is a "152W00000X" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 723151 . This is a "152W00000X" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: W15619 . This is a "152W00000X" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1699852 . This is a "152W00000X" identifier . This identifiers is of the category "OTHER".
  • Identifier: 15391 . This is a "152W00000X" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 6895447 . This is a "152W00000X" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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