Provider Demographics
NPI:1952354334
Name:JARVIS, RICHARD GERARD (OD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:GERARD
Last Name:JARVIS
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:PO BOX 1025
Mailing Address - Street 2:34 CONNORS STREET
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-6025
Mailing Address - Country:US
Mailing Address - Phone:978-632-8783
Mailing Address - Fax:978-632-4873
Practice Address - Street 1:34 CONNORS ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-2605
Practice Address - Country:US
Practice Address - Phone:978-632-8783
Practice Address - Fax:978-632-4873
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2728152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0344478Medicaid
MA0344478Medicaid
MA0183040001Medicare NSC
MAT59312Medicare UPIN