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General NPI Number Information
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NPI Number | 1609969229
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Entity Type | Individual
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Provider Name | JEANETTE MARIE SEWELL O.D.
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Gender | Female
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 06/08/2012
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Provider Practice Location Address
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Address Line | 10 LINCOLN SQ EYE AND VISION CENTER
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City | WORCESTER
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State | MA
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Zip | 01608-1135
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Country | US
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Telephone | 508-373-5726
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Fax |
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Provider Business Mailing Address
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Address Line | 10 LINCOLN SQ EYE AND VISION CENTER
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City | WORCESTER
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State | MA
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Zip | 01608-1135
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Country | US
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Telephone | 508-373-5726
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2949
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License Number State | MA
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