Healthcare Provider Details

I. General information

NPI: 1518119494
Provider Name (Legal Business Name): CYNTHIA JEAN MAYO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2008
Last Update Date: 04/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 ROUTE 28 SUITE 206
WEST HARWICH MA
02671-0024
US

IV. Provider business mailing address

P.O. BOX 24 120 ROUTE 28
WEST HARWICH MA
02671-0024
US

V. Phone/Fax

Practice location:
  • Phone: 508-432-4706
  • Fax: 508-432-2020
Mailing address:
  • Phone: 508-432-4706
  • Fax: 508-432-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number5961
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number5961
License Number StateMA

VIII. Authorized Official

Name: MRS. CYNTHIA J MAYO
Title or Position: OWNER
Credential: LICENSED OPTICIAN
Phone: 508-432-4706