Provider Demographics
NPI:1700979978
Name:PRENTISS, WILLIAM MOSER (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MOSER
Last Name:PRENTISS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:85 CONSTITUTION LANE, SUITE 100C
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923
Mailing Address - Country:US
Mailing Address - Phone:978-774-7033
Mailing Address - Fax:978-774-0341
Practice Address - Street 1:85 CONSTITUTION LANE, SUITE 100C
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923
Practice Address - Country:US
Practice Address - Phone:978-774-7033
Practice Address - Fax:978-774-0341
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3725152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0392316Medicaid
MA755413OtherTUFTS
MA3330581OtherAETNA
MA9787747033OtherVISION SERVICE PLAN
MAVC6000251585AD001OtherMASS REHAB COMMISSION
MA151089OtherHARVARD PILGRM
MA0035493OtherNEIGHBORHOOD HEALTH PLAN
MAW15990OtherBLUE CROSS BLUE SHIELD
MA42852OtherDAVIS VISION
MA59234OtherFALLON
MA0392316Medicaid
MA3330581OtherAETNA
MAPRW17201Medicare ID - Type Unspecified