Provider Demographics
NPI:1518966449
Name:MERTZ, JANIS FAITH (OD)
Entity Type:Individual
Prefix:DR
First Name:JANIS
Middle Name:FAITH
Last Name:MERTZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 CORDAGE PARK CIR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-7331
Mailing Address - Country:US
Mailing Address - Phone:508-747-3937
Mailing Address - Fax:508-474-0104
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
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3047152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0356638Medicaid
MA0356638Medicaid
U35392Medicare UPIN
6368240001Medicare NSC