Healthcare Provider Details

I. General information

NPI: 1427351295
Provider Name (Legal Business Name): SUDBURY EYE CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2010
Last Update Date: 01/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 BOSTON POST ROAD
SUDBURY MA
01776-3058
US

IV. Provider business mailing address

344 BOSTON POST ROAD
SUDBURY MA
01776-3058
US

V. Phone/Fax

Practice location:
  • Phone: 978-443-3021
  • Fax:
Mailing address:
  • Phone: 978-443-3021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4334
License Number StateMA

VIII. Authorized Official

Name: DR. LORRAINE LABIENTO SMITH
Title or Position: OWNER
Credential: OD
Phone: 978-443-3021