Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 5948 | MA |
NPI | 1205450129 |
---|---|
Provider Name | Mr. Yves Constant |
First Address | Springfield, MA 01109-2632 |
Second Address | Southampton, MA 01073-9274 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2020 |
Last Update Date | 05/06/2020 |