Provider Demographics
NPI:1841302957
Name:MARCHETTO, GAIL SUSAN (OD)
Entity type:Individual
Prefix:DR
First Name:GAIL
Middle Name:SUSAN
Last Name:MARCHETTO
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 1:1132 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1511
Mailing Address - Country:US
Mailing Address - Phone:781-878-2300
Mailing Address - Fax:781-878-2382
Practice Address - Street 1:1132 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1511
Practice Address - Country:US
Practice Address - Phone:781-878-2300
Practice Address - Fax:781-878-2382
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4225152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0335436Medicaid
MA5990110001Medicare NSC
MAW17379Medicare PIN
MAU86588Medicare UPIN