Individual
MR. JERRY P WILL SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DISPENSING OPTICIAN
Contact information
Practice address
15 B COLLEGE HIGHWAY, 15 B SOUTHAMPTON OPTICAL, SOUTHAMPTON, MA 01073
(413) 527-5613
(413) 527-3526
Mailing address
15 B COLLEGE HIGHWAY, SOUTHAMPTON OPTICAL, SOUTHAMPTON, MA 01073
(413) 527-5613
(413) 527-3526
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
MA4110
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0313033
—
MA
Enumeration date
04/12/2007
Last updated
07/08/2007
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