=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043334386
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAPE OPTICIANS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2007
-----------------------------------------------------
Last Update Date | 07/03/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 583 IYANNOUGH RD
-----------------------------------------------------
City | HYANNIS
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02601-1929
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-771-2205
-----------------------------------------------------
Fax | 508-778-1973
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 583 IYANNOUGH RD
-----------------------------------------------------
City | HYANNIS
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02601-1929
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-771-2205
-----------------------------------------------------
Fax | 508-778-1973
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. WAYNE L PADDOCK
-----------------------------------------------------
Credential | RDO
-----------------------------------------------------
Telephone | 508-771-2205
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number | 1271
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------