Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 4022 | MA |
NPI | 1003806167 |
---|---|
Provider Name | Fatima Raposo |
First Address | Fall River, MA 02720-2972 |
Second Address | Fall River, MA 02720-2972 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2005 |
Last Update Date | 04/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0372081 | (05) | MA |
U67122 | (02) |