Provider Demographics
NPI:1245667179
Name:RODERICK D LORENTE
Entity type:Organization
Organization Name:RODERICK D LORENTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RODERICK
Authorized Official - Middle Name:DANA
Authorized Official - Last Name:LORENTE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:508-668-0047
Mailing Address - Street 1:39 WHITNEY ROAD
Mailing Address - Street 2:
Mailing Address - City:HARVARD
Mailing Address - State:MA
Mailing Address - Zip Code:02081-4231
Mailing Address - Country:US
Mailing Address - Phone:508-668-0047
Mailing Address - Fax:508-668-6415
Practice Address - Street 1:39 WHITNEY ROAD
Practice Address - Street 2:
Practice Address - City:HARVARD
Practice Address - State:MA
Practice Address - Zip Code:01457-1405
Practice Address - Country:US
Practice Address - Phone:978-502-3427
Practice Address - Fax:508-668-6415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-10
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2535152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty