Provider Demographics
NPI:1366469090
Name:LORENTE, RODERICK D (OD)
Entity type:Individual
Prefix:
First Name:RODERICK
Middle Name:D
Last Name:LORENTE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 WHITNEY RD
Mailing Address - Street 2:
Mailing Address - City:HARVARD
Mailing Address - State:MA
Mailing Address - Zip Code:01451-1405
Mailing Address - Country:US
Mailing Address - Phone:978-456-8189
Mailing Address - Fax:
Practice Address - Street 1:550 PROVIDENCE HWY
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-4231
Practice Address - Country:US
Practice Address - Phone:508-668-0047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2535152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0336416Medicaid
MA179558Medicare PIN
MA0336416Medicaid