Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 5947 | MA |
NPI | 1023483427 |
---|---|
Provider Name | Lia Iacono |
First Address | Boston, MA 02111 |
Second Address | Boston, MA 02111 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2015 |
Last Update Date | 10/12/2015 |