Provider Demographics
NPI:1437353968
Name:DR JANIS F MERTZ PC
Entity Type:Organization
Organization Name:DR JANIS F MERTZ PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANIS
Authorized Official - Middle Name:FAITH
Authorized Official - Last Name:MERTZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:508-747-3937
Mailing Address - Street 1:10 WAGON WHEEL RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-3481
Mailing Address - Country:US
Mailing Address - Phone:508-747-3937
Mailing Address - Fax:508-747-0104
Practice Address - Street 1:36 CORDAGE PARK CIR
Practice Address - Street 2:SUITE 108
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-7331
Practice Address - Country:US
Practice Address - Phone:508-747-3937
Practice Address - Fax:508-747-0104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3047152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0356638Medicaid
MAAA2331OtherHARVARD PILGRIM
MAW20489OtherBLUE CROSS BLUE SHIELD
MAU35392Medicare UPIN
MA6368240001Medicare NSC
MAW20489OtherBLUE CROSS BLUE SHIELD