Provider Demographics
NPI:1467661710
Name:MASSEY, DOROTHY ELIZABETH (OPHTHALMIC DISPENSER)
Entity Type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:ELIZABETH
Last Name:MASSEY
Suffix:
Gender:F
Credentials:OPHTHALMIC DISPENSER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 ARNOLD AVENUE
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-0502
Mailing Address - Country:US
Mailing Address - Phone:732-899-1381
Mailing Address - Fax:732-892-4418
Practice Address - Street 1:617 ARNOLD AVENUE
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT BEACH
Practice Address - State:NJ
Practice Address - Zip Code:08742-0502
Practice Address - Country:US
Practice Address - Phone:732-899-1381
Practice Address - Fax:732-892-4418
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
0615640001OtherMEDICARE PIN