Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FC0801X | Contact Lens Fitter | MA5553 | MA |
Y | 156FX1800X | Optician | MA5553 | MA |
NPI | 1104592930 |
---|---|
Provider Name | Jonathan Parrelli |
First Address | Danvers, MA 01923-2835 |
Second Address | Danvers, MA 01923-2835 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2021 |
Last Update Date | 20/08/2021 |