Provider Demographics
NPI:1518119494
Name:CYNTHIA JEAN MAYO
Entity Type:Organization
Organization Name:CYNTHIA JEAN MAYO
Other - Org Name:HARWICH OPTICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAYO
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED OPTICIAN
Authorized Official - Phone:508-432-4706
Mailing Address - Street 1:P.O. BOX 24
Mailing Address - Street 2:120 ROUTE 28
Mailing Address - City:WEST HARWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02671-0024
Mailing Address - Country:US
Mailing Address - Phone:508-432-4706
Mailing Address - Fax:508-432-2020
Practice Address - Street 1:120 ROUTE 28
Practice Address - Street 2:SUITE 206
Practice Address - City:WEST HARWICH
Practice Address - State:MA
Practice Address - Zip Code:02671-0024
Practice Address - Country:US
Practice Address - Phone:508-432-4706
Practice Address - Fax:508-432-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5961156FX1800X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5689000001Medicare NSC