Healthcare Provider Details

I. General information

NPI: 1235396755
Provider Name (Legal Business Name): MASHPEE VISION CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

681 FALMOUTH RD SUITE B12
MASHPEE MA
02649-3327
US

IV. Provider business mailing address

681 FALMOUTH RD UPPER LEVEL
MASHPEE MA
02649-3327
US

V. Phone/Fax

Practice location:
  • Phone: 508-477-1802
  • Fax: 508-539-3713
Mailing address:
  • Phone: 508-477-1802
  • Fax: 508-539-3713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2864
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. BARBARA LYNNE GROVE
Title or Position: OWNER
Credential: OD
Phone: 508-477-1802