Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 3326 | MA |
NPI | 1003945296 |
---|---|
Provider Name | Dr. Peter John Violette |
First Address | Wakefield, MA 01880-2300 |
Second Address | Wakefield, MA 01880-2300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2007 |
Last Update Date | 26/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
15158-5 | HARVARD PILGRIM (01) | MA |
716213 | TUFTS (01) | MA |
T79630 | (02) | MA |
W15753 | BLUE CROSS AND BLUE SHIEL (01) | MA |