Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 3806 | MA |
NPI | 1013057082 |
---|---|
Provider Name | Dr. Thomas R Corwin |
First Address | Cambridge, MA 02138-1023 |
Second Address | Burlington, MA 01803-4914 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2007 |
Last Update Date | 08/07/2007 |