Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FC0801X | Contact Lens Fitter | 6297 | MA |
Y | 156FX1800X | Optician | 6297 | MA |
NPI | 1912398793 |
---|---|
Provider Name | Andrea Desimone |
First Address | North Reading, MA 01864-2236 |
Second Address | Cambridge, MA 02140-1431 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2015 |
Last Update Date | 14/02/2015 |