Provider Demographics
NPI:1235336850
Name:MULVEHILL, BRENDA L (OD)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:L
Last Name:MULVEHILL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 POWERS RD
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-1028
Mailing Address - Country:US
Mailing Address - Phone:978-443-4193
Mailing Address - Fax:
Practice Address - Street 1:200 OTIS ST
Practice Address - Street 2:
Practice Address - City:NORTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532-2442
Practice Address - Country:US
Practice Address - Phone:508-393-3155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3318152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist