Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FC0800X | Contact Lens | 4043 | MA |
Y | 156FX1800X | Optician | 4043 | MA |
NPI | 1619007333 |
---|---|
Provider Name | Mr. Salvatore N Imperato |
First Address | South Barre, MA 01074 |
Second Address | South Barre, MA 01074 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2007 |
Last Update Date | 01/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110028800A | MASSHEALTH HEARING (01) | MA |
110028800B | MASSHEALTH (01) | MA |
1537903 | (05) | MA |
45806 | FALLON (01) | MA |
95162501 | NETWORKHEALTH (01) | MA |
BAROPT123 | UNICARE (01) | MA |
OP2873 | EYEMED (01) | MA |