Healthcare Provider Details

I. General information

NPI: 1689590739
Provider Name (Legal Business Name): MARTHAS VINEYARD EYE CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 SURVEYORS LANE #10
VINEYARD HAVEN MA
02568
US

IV. Provider business mailing address

P.O. BOX 4613 1 LAGOON POND RD
VINEYARD HAVEN MA
02568-5514
US

V. Phone/Fax

Practice location:
  • Phone: 617-468-1741
  • Fax:
Mailing address:
  • Phone: 617-312-0272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. LAUREN DICKERMAN
Title or Position: PRESIDENT
Credential: OD
Phone: 617-312-0272