Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FC0800X | Contact Lens | 5477 | MA |
N | 156FC0801X | Contact Lens Fitter | 5477 | MA |
Y | 156FX1800X | Optician | 5477 | MA |
NPI | 1538510318 |
---|---|
Provider Name | Leonid Demihovsky |
First Address | Worcester, MA 01608-2019 |
Second Address | Worcester, MA 01608-2019 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2016 |
Last Update Date | 23/06/2016 |