Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 3365 | MA |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 3365 | MA |
N | 152WP0200X | Pediatric Optomitrist | 3365 | MA |
N | 152WV0400X | Optomitrist - Vision Therapist | 3365 | MA |
N | 152WX0102X | Occupational Vision | 3365 | MA |
NPI | 1346229655 |
---|---|
Provider Name | Dr. Laura Anne Potvin |
First Address | Groveland, MA 01834-1565 |
Second Address | Groveland, MA 01834-1565 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2006 |
Last Update Date | 18/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
353833 | (05) | MA |
T59421 | (02) | MA |