Healthcare Provider Details

I. General information

NPI: 1134341670
Provider Name (Legal Business Name): MEDFIELD EYE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 NORTH STREET
MEDFIELD MA
02052
US

IV. Provider business mailing address

55 NORTH STREET
MEDFIELD MA
02052
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number4786
License Number StateMA

VIII. Authorized Official

Name: MARY KEENAN
Title or Position: OWNER
Credential:
Phone: 508-359-9969