Healthcare Provider Details

I. General information

NPI: 1205894433
Provider Name (Legal Business Name): CATHY STERN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 08/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 CEDAR DR
CANTON MA
02021-1141
US

IV. Provider business mailing address

7 CEDAR DR
CANTON MA
02021-1141
US

V. Phone/Fax

Practice location:
  • Phone: 781-575-0057
  • Fax:
Mailing address:
  • Phone: 781-575-0057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number2816
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: