1346284577 NPI number — DR. WAYNE HJERPE O.D.

Table of content: DR. WAYNE HJERPE O.D. (NPI 1346284577)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346284577 NPI number — DR. WAYNE HJERPE O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HJERPE
Provider First Name:
WAYNE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1346284577
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 752
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST HARWICH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02671-0752
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-432-0020
Provider Business Mailing Address Fax Number:
508-432-7600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 ROUTE 28
Provider Second Line Business Practice Location Address:
SUITE 200, BOX 752
Provider Business Practice Location Address City Name:
WEST HARWICH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02671-0752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-432-0020
Provider Business Practice Location Address Fax Number:
508-432-7600
Provider Enumeration Date:
06/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OP2916-TP , 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: 0351822 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 410008252 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: W15686 . This is a "BLUE CROSS BLUE SHIELD PR" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0506480001 . This is a "DMERC HEALTH NOW DURABLE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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