Provider Demographics
NPI:1881766038
Name:PANTANO, YEN M (OD)
Entity type:Individual
Prefix:DR
First Name:YEN
Middle Name:M
Last Name:PANTANO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:YEN
Other - Middle Name:
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:40 ROCKLAND ST
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-5854
Mailing Address - Country:US
Mailing Address - Phone:617-270-3256
Mailing Address - Fax:
Practice Address - Street 1:81 SPEEN ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-4168
Practice Address - Country:US
Practice Address - Phone:508-820-8844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4269152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA4269OtherMA LICENSE