Provider Demographics
NPI:1851607014
Name:MAULT, KENDALL LORAINE HARER (OD)
Entity Type:Individual
Prefix:DR
First Name:KENDALL
Middle Name:LORAINE HARER
Last Name:MAULT
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 1:116R HIGHLAND AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-2723
Mailing Address - Country:US
Mailing Address - Phone:978-745-0654
Mailing Address - Fax:
Practice Address - Street 1:116R HIGHLAND AVE FL 2
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2723
Practice Address - Country:US
Practice Address - Phone:978-745-0654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4800152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist