Provider Demographics
NPI:1609969229
Name:SEWELL, JEANETTE MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:MARIE
Last Name:SEWELL
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 1:10 LINCOLN SQ
Mailing Address - Street 2:EYE AND VISION CENTER
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1135
Mailing Address - Country:US
Mailing Address - Phone:508-373-5726
Mailing Address - Fax:
Practice Address - Street 1:10 LINCOLN SQ
Practice Address - Street 2:EYE AND VISION CENTER
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1135
Practice Address - Country:US
Practice Address - Phone:508-373-5726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2949152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U12863Medicare UPIN
444758Medicare ID - Type Unspecified