Provider Demographics
NPI:1104922202
Name:COTTER, JANIS M (OD)
Entity type:Individual
Prefix:DR
First Name:JANIS
Middle Name:M
Last Name:COTTER
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 1:80 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-5305
Mailing Address - Country:US
Mailing Address - Phone:781-289-7929
Mailing Address - Fax:
Practice Address - Street 1:80 BROADWAY
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-5305
Practice Address - Country:US
Practice Address - Phone:781-289-7929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3221152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA36880OtherHEALTH NEW ENGLAND
MA0027563OtherNEIGHBORHOOD HEALTH PLAN
MA2219OtherFALLON HEALTH PLAN
MA670120OtherCIGNA
MA725436OtherTUFTS HEALTH PLAN
MA153338OtherHARVARD PILGRIM
MA99369301OtherNETWORK HEALTH
MA53581OtherCHILDRENS MEDICAL SECURIT
MAW15695OtherBLUE CROSS BLUE SHIELD
MA0353094Medicaid
MA3281178OtherAETNA
MA670120OtherCIGNA
MA725436OtherTUFTS HEALTH PLAN