Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FC0801X | Contact Lens Fitter | 1726 | MA |
Y | 156FX1800X | Optician | 1726 | MA |
NPI | 1154591238 |
---|---|
Provider Name | Mr. Morgan Scott Sullivan |
First Address | Framingham, MA 01701-3136 |
Second Address | Framingham, MA 01701-3136 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2008 |
Last Update Date | 05/03/2008 |