Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 5255 | MA |
N | 152W00000X | Optometrist | 6440 | OH |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 6440 | OH |
NPI | 1174974380 |
---|---|
Provider Name | Bita Asghari |
First Address | Needham, MA 02494 |
Second Address | Needham, MA 02494-1228 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2016 |
Last Update Date | 17/03/2018 |