Provider Demographics
NPI:1255363321
Name:SULLIVAN, GARRETT F (OD)
Entity type:Individual
Prefix:DR
First Name:GARRETT
Middle Name:F
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 POPE ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:MA
Mailing Address - Zip Code:01749-2182
Mailing Address - Country:US
Mailing Address - Phone:978-562-7976
Mailing Address - Fax:978-562-4807
Practice Address - Street 1:34 POPE ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:MA
Practice Address - Zip Code:01749-2182
Practice Address - Country:US
Practice Address - Phone:978-562-7976
Practice Address - Fax:978-562-4807
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2233152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0350559Medicaid
MAMA2233OtherEYEMED
11223238OtherUNITED HEALTH CARE
MA261552128OtherFALLON
MA261552128OtherCHILDRENS MEDICAL SEC PL
MA261552128OtherGIC
MA261552128OtherUNICARE
MA261552128OtherVSP
MA47545OtherSPECTERA
MA700882OtherTUFTS
MA261552128OtherTRICARE
W15302OtherBLUECROSS BLUE SHIELD
MA242750OtherCIGNA
MAT59348OtherHEALTH PLANS
MA043072755OtherFALLON
MA6000000016OtherHARVARD PILGRIM
81117OtherAETNA
MA700882OtherTUFTS
81117OtherAETNA