Healthcare Provider Details

I. General information

NPI: 1699602821
Provider Name (Legal Business Name): EDEN LATOUR MARCO OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 MA-132
HYANNIS MA
02601
US

IV. Provider business mailing address

22 FINGER LN UNIT B
OSTERVILLE MA
02655-1624
US

V. Phone/Fax

Practice location:
  • Phone: 508-771-9701
  • Fax:
Mailing address:
  • Phone: 508-523-5504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT8398
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: