Provider Demographics
NPI:1174131882
Name:CIVETTI, ERIN (OD)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:CIVETTI
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 1:7 BEAR HILL RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-3619
Mailing Address - Country:US
Mailing Address - Phone:508-577-3367
Mailing Address - Fax:
Practice Address - Street 1:41 ANDREW AVE
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778-3026
Practice Address - Country:US
Practice Address - Phone:508-426-5092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5414152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist