Healthcare Provider Details

I. General information

NPI: 1689863623
Provider Name (Legal Business Name): JENNIFER DAMICO OCONNOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 N MAIN ST
NORTH BROOKFIELD MA
01535
US

IV. Provider business mailing address

355 NORTH MAIN STREET
NORTH BROOKFIELD MA
01535
US

V. Phone/Fax

Practice location:
  • Phone: 508-867-3755
  • Fax:
Mailing address:
  • Phone: 508-867-3755
  • Fax: 508-867-7832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3785
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number3786
License Number StateMA

VIII. Authorized Official

Name: DR. JENNIFER DAMICO OCONNOR
Title or Position: OWNER
Credential: OD
Phone: 508-867-3755