Healthcare Provider Details

I. General information

NPI: 1588651913
Provider Name (Legal Business Name): SUSAN P. PREWANDOWSKI O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 WINTHROP ST
TAUNTON MA
02780-4242
US

IV. Provider business mailing address

64 WINTHROP ST
TAUNTON MA
02780-4242
US

V. Phone/Fax

Practice location:
  • Phone: 508-823-5536
  • Fax: 508-880-3798
Mailing address:
  • Phone: 508-823-5536
  • Fax: 508-880-3798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3451
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: