Provider Demographics
NPI:1700113263
Name:HIRSHOM, WILLIAM B (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:B
Last Name:HIRSHOM
Suffix:
Gender:M
Credentials:OPTICIAN
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 2825
Mailing Address - Street 2:380 SOUTH ST
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601
Mailing Address - Country:US
Mailing Address - Phone:508-771-3889
Mailing Address - Fax:508-771-3889
Practice Address - Street 1:380 SOUTH ST
Practice Address - Street 2:RIGHT WALKWAY
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601
Practice Address - Country:US
Practice Address - Phone:508-771-3889
Practice Address - Fax:508-771-3889
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4216(OPTICIAN)332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier