1831127182 NPI number — DR. JEFFREY A WESSON O.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831127182 NPI number — DR. JEFFREY A WESSON O.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

WESSON

Provider First Name:

JEFFREY

Provider Middle Name:

A

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

O.D.

Provider Gender Code:

M

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:

1831127182

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

05/01/2012

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

118 NEWTOWN RD

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

ACTON

Provider Business Mailing Address State Name:

MA

Provider Business Mailing Address Postal Code:

01720-3130

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

978-263-8521

Provider Business Mailing Address Fax Number:

978-263-7319

Provider First Line Business Practice Location Address:

296 GREAT RD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

ACTON

Provider Business Practice Location Address State Name:

MA

Provider Business Practice Location Address Postal Code:

01720-4710

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

978-263-8521

Provider Business Practice Location Address Fax Number:

978-263-7319

Provider Enumeration Date:

06/28/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 152W00000X , with the licence number:  2356 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0019264 . This is a "NEIGHBORHOOD HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 5892591-001 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 22-00509 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 64611 . This is a "FALLON" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: W15180 . This is a "HMO BLUE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 15355 . This is a "HEALTHSOURCE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 60640 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 404799 . This is a "TUFTS MEDICARE PREFERRED" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: AMA105 . This is a "FREEDOM HARVARD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 0323217 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
• Identifier: 404799 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: AMA105 . This is a "HARVARD PILGRIM HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".