Provider Demographics
NPI:1235396755
Name:MASHPEE VISION CARE
Entity Type:Organization
Organization Name:MASHPEE VISION CARE
Other - Org Name:B LYNNE GROVE OD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:GROVE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:508-477-1802
Mailing Address - Street 1:681 FALMOUTH RD
Mailing Address - Street 2:UPPER LEVEL
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-3327
Mailing Address - Country:US
Mailing Address - Phone:508-477-1802
Mailing Address - Fax:508-539-3713
Practice Address - Street 1:681 FALMOUTH RD
Practice Address - Street 2:SUITE B12
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-3327
Practice Address - Country:US
Practice Address - Phone:508-477-1802
Practice Address - Fax:508-539-3713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2864152W00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA12434Other152W00000X
MA0352446Medicaid
MA454369Other152W00000X
MAOP3143Other152W00000X
MA201700019Other152W00000X
MA2200561Other152W00000X
MA233717Other152W00000X
000001377Other152W00000X
MA1101851567Other152W00000X
MA1235396755Other152W00000X
MAS012088Other152W00000X
MA20838343610Other152W00000X
MA723151Other152W00000X
MAW15619Other152W00000X
1699852Other152W00000X
MA15391Other152W00000X
MA6895447Other152W00000X
MA12434Other152W00000X