Individual
DR. JEANINE PREVOST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
1287 WILBUR AVE, SOMERSET, MA 02725-1816
(508) 673-2140
Mailing address
1287 WILBUR AVE, SOMERSET, MA 02725-1816
(508) 676-2140
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3366
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0393827
—
MA
01
—
0950210001
MEDICARE REGION A DMERC
—
01
—
151265
HARVARD PILGRIM HEALTH CARE
—
01
—
4877-6
BLUE CROSS OF RI
—
01
—
W15984
BLUE CROSS BLUE SHIELD OF MASSACHUSETTS
—
Enumeration date
07/22/2005
Last updated
06/18/2010
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