MEDICARE: JEANINE PREVOST DBA SOMERSET EYE CARE

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	3366	MA

General Provider Information

NPI Number	:	1497944003
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEANINE PREVOST DBA SOMERSET EYE CARE

Provider Business Mailing Address
First Line	:	1287 WILBUR AVE
Second Line	:
City	:	SOMERSET
State	:	MA
Zip	:	02725-1816
Country	:	US
Telephone Number	:	508-676-2140
Fax Number	:

Provider Business Practice Location Address
First Line	:	1287 WILBUR AVE
Second Line	:
City	:	SOMERSET
State	:	MA
Zip	:	02725-1816
Country	:	US
Telephone Number	:	508-676-2140
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JEANINE PREVOST
Credential	:	OD
Telephone Number	:	508-676-2140

Provider Enumeration Date	:	10/19/2007
Last Update Date	:	06/18/2008

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