Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 4966 | MA |
NPI | 1174894414 |
---|---|
Provider Name | Lisa R Trainor |
First Address | Mendon, MA 01756-1017 |
Second Address | Mendon, MA 01756-1017 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2012 |
Last Update Date | 18/01/2012 |