Provider Demographics
NPI:1174761480
Name:DR. ANTOINETTE D. PARVIS, PC
Entity type:Organization
Organization Name:DR. ANTOINETTE D. PARVIS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTOINETTE
Authorized Official - Middle Name:DOMENICA
Authorized Official - Last Name:PARVIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:508-987-3237
Mailing Address - Street 1:216 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01540-3310
Mailing Address - Country:US
Mailing Address - Phone:508-987-3237
Mailing Address - Fax:508-987-0494
Practice Address - Street 1:216 MAIN ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MA
Practice Address - Zip Code:01540-3310
Practice Address - Country:US
Practice Address - Phone:508-987-3237
Practice Address - Fax:508-987-0494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3698-TP152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0369926Medicaid
MA467304OtherEYE-MED
MA980429OtherAETNA
MA43499OtherCIGNA
MAW16082OtherBLUE-CROSS/BLUE SHIELD
MA115185OtherFALLON SELECT
MA22000OtherUNITED HEALTH CARE
MA980429OtherAETNA