Healthcare Provider Details

I. General information

NPI: 1861883571
Provider Name (Legal Business Name): OPTOMEYES HEALTH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2015
Last Update Date: 03/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 FAUNCE CORNER RD
DARTMOUTH MA
02747-1242
US

IV. Provider business mailing address

535 FAUNCE CORNER RD
DARTMOUTH MA
02747-1242
US

V. Phone/Fax

Practice location:
  • Phone: 508-207-3569
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4182
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number4134
License Number StateMA

VIII. Authorized Official

Name: SHERRY L AUDYCKI
Title or Position: PRESIDENT
Credential: O.D.
Phone: 508-207-3569