Healthcare Provider Details

I. General information

NPI: 1225135593
Provider Name (Legal Business Name): MR. PAUL EDWIN HEARD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 WEST RD
ORLEANS MA
02653
US

IV. Provider business mailing address

9 WEST RD NAUSET OPTICAL
ORLEANS MA
02653
US

V. Phone/Fax

Practice location:
  • Phone: 508-255-6394
  • Fax: 508-255-1696
Mailing address:
  • Phone: 508-255-6394
  • Fax: 508-255-1696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberMA1749
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: