Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 5688 | MA |
NPI | 1174065460 |
---|---|
Provider Name | Leonis De Faria |
First Address | Framingham, MA 01702-8311 |
Second Address | Framingham, MA 01702-8311 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2016 |
Last Update Date | 17/11/2016 |