Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 1304 | MA |
NPI | 1205953304 |
---|---|
Provider Name | Mr. Ronald Arthur Riesz |
First Address | Arlington, MA 02474-5106 |
Second Address | Arlington, MA 02474-5106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2007 |
Last Update Date | 08/07/2007 |