Healthcare Provider Details

I. General information

NPI: 1306159033
Provider Name (Legal Business Name): ANHTHY TRINH PRENDEVILLE O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANHTHY HOANG TRINH O.D.

II. Dates (important events)

Enumeration Date: 07/22/2010
Last Update Date: 03/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 CENTRAL STREET
WELLESLEY MA
02482-5806
US

IV. Provider business mailing address

26 OAK KNOLL ROAD
CARLISLE MA
01741
US

V. Phone/Fax

Practice location:
  • Phone: 617-884-1222
  • Fax:
Mailing address:
  • Phone: 314-368-9155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4804
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: