Provider Demographics
NPI:1619985082
Name:DR. LAURA ANNE POTVIN, P.C.
Entity Type:Organization
Organization Name:DR. LAURA ANNE POTVIN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:POTVIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:508-837-3790
Mailing Address - Street 1:291 MAIN ST
Mailing Address - Street 2:P.O. BOX 232
Mailing Address - City:GROVELAND
Mailing Address - State:MA
Mailing Address - Zip Code:01834-1234
Mailing Address - Country:US
Mailing Address - Phone:508-837-3790
Mailing Address - Fax:978-373-7852
Practice Address - Street 1:291 MAIN ST
Practice Address - Street 2:
Practice Address - City:GROVELAND
Practice Address - State:MA
Practice Address - Zip Code:01834-1234
Practice Address - Country:US
Practice Address - Phone:978-374-8991
Practice Address - Fax:978-373-7852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3365152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAT59421Medicare UPIN
MAU96073Medicare UPIN
MAU28034Medicare UPIN