Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 4873 | MA |
NPI | 1164620936 |
---|---|
Provider Name | Fred L Alfred |
First Address | Attleboro, MA 02703-2441 |
Second Address | Attleboro, MA 02703-2441 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0125610001 | MEDICARE SUPPLIER NUMBER (01) | MA |
102058 | SUPPLIER NUMBER (01) | MA |