Healthcare Provider Details

I. General information

NPI: 1033201330
Provider Name (Legal Business Name): ILANA ORELOWITZ, O.D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 04/20/2020
Certification Date: 04/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 WEST ST
MEDFIELD MA
02052-1577
US

IV. Provider business mailing address

67 WEST ST
MEDFIELD MA
02052-1577
US

V. Phone/Fax

Practice location:
  • Phone: 508-359-9969
  • Fax: 508-359-4255
Mailing address:
  • Phone: 508-837-3790
  • Fax: 508-359-4255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4221
License Number StateMA

VIII. Authorized Official

Name: DR. ILANA ORELOWITZ
Title or Position: DOCTOR/OWNER
Credential: OD
Phone: 508-837-3790