Provider Demographics
NPI:1306159033
Name:PRENDEVILLE, ANHTHY TRINH (OD)
Entity type:Individual
Prefix:MRS
First Name:ANHTHY
Middle Name:TRINH
Last Name:PRENDEVILLE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:ANHTHY
Other - Middle Name:HOANG
Other - Last Name:TRINH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:26 OAK KNOLL ROAD
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:MA
Mailing Address - Zip Code:01741
Mailing Address - Country:US
Mailing Address - Phone:314-368-9155
Mailing Address - Fax:
Practice Address - Street 1:72 CENTRAL STREET
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-5806
Practice Address - Country:US
Practice Address - Phone:617-884-1222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-22
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4804152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist