MEDICARE: DR. JEANINE PREVOST OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	3366	MA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0950210001	OTHER		MEDICARE REGION A DMERC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	W15984	OTHER	BLUE CROSS BLUE SHIELD OF MASSACHUSETTS
3	151265	OTHER	HARVARD PILGRIM HEALTH CARE
4	4877-6	OTHER	BLUE CROSS OF RI
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083614838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEANINE PREVOST OD

Provider Business Mailing Address
First Line	:	1287 WILBUR AVE
Second Line	:
City	:	SOMERSET
State	:	MA
Zip	:	02725-1816
Country	:	US
Telephone Number	:	508-676-2140
Fax Number	:

Provider Business Practice Location Address
First Line	:	1287 WILBUR AVE
Second Line	:
City	:	SOMERSET
State	:	MA
Zip	:	02725-1816
Country	:	US
Telephone Number	:	508-673-2140
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	06/18/2010

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