Healthcare Provider Details

I. General information

NPI: 1497500979
Provider Name (Legal Business Name): CAPE ANN OPTOMETRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2024
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 EASTERN AVE
GLOUCESTER MA
01930-1802
US

IV. Provider business mailing address

52 KNOLL LN
LEVITTOWN NY
11756-2601
US

V. Phone/Fax

Practice location:
  • Phone: 351-217-8052
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. LLOYD HASKES
Title or Position: OPTOMETRIST
Credential: OD
Phone: 917-705-4464