Provider Demographics
NPI:1679559108
Name:AUDYCKI, SHERRY L (OD)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:L
Last Name:AUDYCKI
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 1:128 ROCKLAND ST
Mailing Address - Street 2:
Mailing Address - City:DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02748-2363
Mailing Address - Country:US
Mailing Address - Phone:508-993-3111
Mailing Address - Fax:
Practice Address - Street 1:535 FAUNCE CORNER RD
Practice Address - Street 2:OPTOMEYES HEALTH,PC
Practice Address - City:N DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-1242
Practice Address - Country:US
Practice Address - Phone:774-202-6888
Practice Address - Fax:774-992-0188
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4182152W00000X
RIODTA00544152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW17348Medicare PIN
U11431Medicare UPIN