Provider Demographics
NPI:1245331776
Name:VANTOSH, PATRICIA BETH (OD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:BETH
Last Name:VANTOSH
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:PO BOX 2030
Mailing Address - Street 2:
Mailing Address - City:DUXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02331
Mailing Address - Country:US
Mailing Address - Phone:781-934-6945
Mailing Address - Fax:781-934-1351
Practice Address - Street 1:27 RAILROAD AVE
Practice Address - Street 2:STE 1
Practice Address - City:DUXBURY
Practice Address - State:MA
Practice Address - Zip Code:02332
Practice Address - Country:US
Practice Address - Phone:781-934-6945
Practice Address - Fax:781-934-1351
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2769152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA15298OtherHARVARD PILGRIM
732768OtherTUFTS SECURE HORIZONS
MAW15589OtherBLUE CROSS
0428OtherUNITED HEALTH CARE
454743OtherUS HEALTH
PA208158OtherCIGNA
6711OtherUNITED HEALTH CARE
MA0346691Medicaid
MAW15589OtherBLUE CROSS
PA208158OtherCIGNA
MA1245331776Medicare NSC