Provider Demographics
NPI:1518512482
Name:NYSSA . A. D'HEDOUVILLE OD LLC
Entity Type:Organization
Organization Name:NYSSA . A. D'HEDOUVILLE OD LLC
Other - Org Name:MASHPEE VISION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:NYSSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:D'HEDOUVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:508-477-1802
Mailing Address - Street 1:681 FALMOUTH ROAD
Mailing Address - Street 2:UPPER LEVEL SUITE 25
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-6310
Mailing Address - Country:US
Mailing Address - Phone:508-477-1802
Mailing Address - Fax:508-539-3713
Practice Address - Street 1:681 FALMOUTH ROAD
Practice Address - Street 2:UPPER LEVEL SUITE 25
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-6310
Practice Address - Country:US
Practice Address - Phone:508-477-1802
Practice Address - Fax:508-539-3713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-07
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty