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General NPI Number Information
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NPI Number | 1548477821
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Entity Type | Organization
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Legal Business Name | CEDARVILLE EYE ASSOCIATES PC
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 04/07/2020
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Provider Practice Location Address
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Address Line | 2277 STATE RD SUITE F
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City | PLYMOUTH
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State | MA
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Zip | 02360-7111
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Country | US
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Telephone | 508-888-6393
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Fax | 508-833-3551
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Provider Business Mailing Address
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Address Line | 2277 STATE RD SUITE F
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City | PLYMOUTH
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State | MA
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Zip | 02360-7111
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Country | US
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Telephone | 508-837-3790
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Fax | 508-833-3551
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. HARRY G CHURCHILL JR.
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Credential | O.D.
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Telephone | 508-837-3790
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3288
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License Number State | MA
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