Provider Demographics
NPI:1134971682
Name:CEDARVILLE EYE PC
Entity type:Organization
Organization Name:CEDARVILLE EYE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:HENTSCHEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:978-505-9314
Mailing Address - Street 1:2277 STATE RD UNIT F
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-7111
Mailing Address - Country:US
Mailing Address - Phone:508-888-6393
Mailing Address - Fax:508-833-3551
Practice Address - Street 1:2277 STATE RD UNIT F
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-7111
Practice Address - Country:US
Practice Address - Phone:508-888-6393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-05
Last Update Date:2024-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty