Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 5332 | MA |
NPI | 1205461704 |
---|---|
Provider Name | Mr. Noah Stern Shriber |
First Address | Lexington, MA 02421-5406 |
Second Address | Lexington, MA 02421-5406 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2020 |
Last Update Date | 05/03/2020 |