Provider Demographics
NPI:1275885519
Name:STURTEVANT, DEREK (OD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:
Last Name:STURTEVANT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 MAIN ST STE 106
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062-3100
Mailing Address - Country:US
Mailing Address - Phone:413-584-6422
Mailing Address - Fax:413-584-4346
Practice Address - Street 1:40 MAIN ST STE 106
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MA
Practice Address - Zip Code:01062-3100
Practice Address - Country:US
Practice Address - Phone:413-584-6422
Practice Address - Fax:413-584-4346
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD60567880152W00000X, 152W00000X
MA5482152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist