Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist |
NPI | 1639621733 |
---|---|
Provider Name | Eric Jahrling |
First Address | Burlington, MA 01803-4983 |
Second Address | Burlington, MA 01803-4983 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2016 |
Last Update Date | 24/07/2020 |