Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 5887 | MA |
N | 156FX1800X | Optician | OP00320 | RI |
NPI | 1013200575 |
---|---|
Provider Name | Heidi Elise Martin |
First Address | Sharon, MA 02067-1719 |
Second Address | Salem, NH 03079-2145 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2011 |
Last Update Date | 17/05/2011 |