Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FC0800X | Contact Lens | 5128 | MA |
Y | 156FC0801X | Contact Lens Fitter | 5128 | MA |
N | 156FX1700X | Ocularist | 5128 | MA |
N | 156FX1800X | Optician | 5128 | MA |
NPI | 1528365053 |
---|---|
Provider Name | Edson Lino |
First Address | Somerville, MA 02143-2914 |
Second Address | Somerville, MA 02143-2914 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2011 |
Last Update Date | 18/02/2011 |