Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 1889 | MA |
NPI | 1134258429 |
---|---|
Provider Name | Lori Ellen Epstein |
First Address | Boston, MA 02109-2908 |
Second Address | Boston, MA 02109-2908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MA1889 | EYEMED (01) | MA |