Individual
JANE PENTHENY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
111 GROSSMAN DR, BRAINTREE, MA 02184-4997
(781) 849-2295
(781) 849-2514
Mailing address
147 MILK ST, PROVIDER ENROLLMENT - 9TH FLOOR, BOSTON, MA 02109-4806
(617) 421-2508
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3362
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0014540
NHP
MA
01
—
003362
TUFTS
MA
05
—
0393711
—
MA
01
—
9390295-002
CIGNA
MA
01
—
E199
HPHC
MA
Enumeration date
12/28/2006
Last updated
10/22/2012
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