Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 4758 | MA |
NPI | 1144460692 |
---|---|
Provider Name | Mr. Jeffrey Bostian |
First Address | Easthampton, MA 01027 |
Second Address | Northampton, MA 01060-3348 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2009 |
Last Update Date | 24/02/2009 |