MEDICARE: MRS. REBECCA LYNN MAURER LICENSED DISPENSING

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	156FC0801X	Contact Lens Fitter	6088	MA
2	156FX1100X	Ophthalmic Technician/Technologist
3	156FX1202X	Optometric Technician
4	156FX1800X	Optician	6088	MA

General Provider Information

NPI Number	:	1548961428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REBECCA LYNN MAURER LICENSED DISPENSING

Provider Business Mailing Address
First Line	:	1448 NORTH MAIN STREET
Second Line	:	SUITE 1
City	:	PALMER
State	:	MA
Zip	:	01069
Country	:	US
Telephone Number	:	413-283-2946
Fax Number	:	413-283-3631

Provider Business Practice Location Address
First Line	:	1448 NORTH MAIN STREET
Second Line	:	SUITE 1
City	:	PALMER
State	:	MA
Zip	:	01069
Country	:	US
Telephone Number	:	413-283-2946
Fax Number	:	413-283-3631

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2023
Last Update Date	:	03/16/2023

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