Healthcare Provider Details

I. General information

NPI: 1750478814
Provider Name (Legal Business Name): CAPEWAY OPTICIANS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 PLAIN ST
MARSHFIELD MA
02050-2105
US

IV. Provider business mailing address

709 PLAIN ST
MARSHFIELD MA
02050-2105
US

V. Phone/Fax

Practice location:
  • Phone: 781-834-1616
  • Fax:
Mailing address:
  • Phone: 781-834-1616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number4932
License Number StateMA

VII. Legacy identifiers

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

# 1
Identifier1536036
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name: WENDY BUNTEN
Title or Position: PRESIDENT
Credential:
Phone: 781-834-1616