Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | ||
N | 156FX1800X | Optician | MA1749 | MA |
NPI | 1225135593 |
---|---|
Provider Name | Mr. Paul Edwin Heard |
First Address | Orleans, MA 02653 |
Second Address | Orleans, MA 02653 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 24/04/2013 |