Healthcare Provider Details

I. General information

NPI: 1346284577
Provider Name (Legal Business Name): WAYNE HJERPE O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 12/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 ROUTE 28 SUITE 200, BOX 752
WEST HARWICH MA
02671-0752
US

IV. Provider business mailing address

PO BOX 752
WEST HARWICH MA
02671-0752
US

V. Phone/Fax

Practice location:
  • Phone: 508-432-0020
  • Fax: 508-432-7600
Mailing address:
  • Phone: 508-432-0020
  • Fax: 508-432-7600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOP2916-TP
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: