=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356539829
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GERALDINE MAYS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2007
-----------------------------------------------------
Last Update Date | 07/03/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 625 COUNTY ST
-----------------------------------------------------
City | TAUNTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02780-3651
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-880-9500
-----------------------------------------------------
Fax | 508-880-9500
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 625 COUNTY ST
-----------------------------------------------------
City | TAUNTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02780-3651
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-880-9500
-----------------------------------------------------
Fax | 508-880-9500
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER OPTICIAN
-----------------------------------------------------
Name | MRS. GERALDINE MAYS
-----------------------------------------------------
Credential | RDO
-----------------------------------------------------
Telephone | 508-880-9500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number | 4521
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------