Provider Demographics
NPI:1346284577
Name:HJERPE, WAYNE (OD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:
Last Name:HJERPE
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:PO BOX 752
Mailing Address - Street 2:
Mailing Address - City:WEST HARWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02671-0752
Mailing Address - Country:US
Mailing Address - Phone:508-432-0020
Mailing Address - Fax:508-432-7600
Practice Address - Street 1:120 ROUTE 28
Practice Address - Street 2:SUITE 200, BOX 752
Practice Address - City:WEST HARWICH
Practice Address - State:MA
Practice Address - Zip Code:02671-0752
Practice Address - Country:US
Practice Address - Phone:508-432-0020
Practice Address - Fax:508-432-7600
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAOP2916-TP152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0351822Medicaid
MA410008252OtherRAILROAD MEDICARE
MAW15686OtherBLUE CROSS BLUE SHIELD PR
MA0506480001OtherDMERC HEALTH NOW DURABLE
MA0506480001OtherDMERC HEALTH NOW DURABLE
MA410008252OtherRAILROAD MEDICARE