MEDICARE: WATERBURY & OLSON OPTOMETRY, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4920	MA

General Provider Information

NPI Number	:	1184975732
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WATERBURY & OLSON OPTOMETRY, P.C.

Provider Business Mailing Address
First Line	:	27 FALMOUTH HEIGHTS RD
Second Line	:
City	:	FALMOUTH
State	:	MA
Zip	:	02540-3660
Country	:	US
Telephone Number	:	508-548-0505
Fax Number	:	508-548-0382

Provider Business Practice Location Address
First Line	:	27 FALMOUTH HEIGHTS RD
Second Line	:
City	:	FALMOUTH
State	:	MA
Zip	:	02540-3660
Country	:	US
Telephone Number	:	508-548-0505
Fax Number	:	508-548-0382

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MATTHEW WATERBURY
Credential	:	O.D.
Telephone Number	:	508-548-0505

Provider Enumeration Date	:	09/23/2012
Last Update Date	:	09/23/2012

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