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General NPI Number Information
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NPI Number | 1689590739
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Entity Type | Organization
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Legal Business Name | MARTHAS VINEYARD EYE CARE INC
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Dates
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Enumeration Date | 06/24/2026
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Last Update Date | 06/24/2026
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Provider Practice Location Address
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Address Line | 26 SURVEYORS LANE #10
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City | VINEYARD HAVEN
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State | MA
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Zip | 02568
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Country | US
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Telephone | 617-468-1741
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 4613 1 LAGOON POND RD
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City | VINEYARD HAVEN
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State | MA
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Zip | 02568-5514
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Country | US
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Telephone | 617-312-0272
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LAUREN DICKERMAN
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Credential | OD
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Telephone | 617-312-0272
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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 |
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License Number State |
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