Provider Demographics
NPI:1942321807
Name:JEFFREY L MORRILL OD PC
Entity Type:Organization
Organization Name:JEFFREY L MORRILL OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MORRILL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:508-528-2040
Mailing Address - Street 1:480 WEST CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MA
Mailing Address - Zip Code:02038-2902
Mailing Address - Country:US
Mailing Address - Phone:508-528-2040
Mailing Address - Fax:508-528-8644
Practice Address - Street 1:480 WEST CENTRAL ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MA
Practice Address - Zip Code:02038-2902
Practice Address - Country:US
Practice Address - Phone:508-528-2040
Practice Address - Fax:508-528-8644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA 2543152W00000X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW15098OtherBLUE CROSS PROVIDER NUMBE
MA0327794Medicaid
154458Medicare PIN
0304860001Medicare NSC
MA0304860001Medicare PIN
T59225Medicare UPIN
MA154458Medicare ID - Type Unspecified