Healthcare Provider Details

I. General information

NPI: 1942321807
Provider Name (Legal Business Name): JEFFREY L MORRILL OD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 WEST CENTRAL ST
FRANKLIN MA
02038-2902
US

IV. Provider business mailing address

480 WEST CENTRAL ST
FRANKLIN MA
02038-2902
US

V. Phone/Fax

Practice location:
  • Phone: 508-528-2040
  • Fax: 508-528-8644
Mailing address:
  • Phone: 508-528-2040
  • Fax: 508-528-8644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberMA 2543
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY L MORRILL
Title or Position: OWNER PRESIDENT
Credential: OD
Phone: 508-528-2040