Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 5532 | MA |
NPI | 1043963895 |
---|---|
Provider Name | Mrs. Annette Ohearn |
First Address | Somerville, MA 02145-3659 |
Second Address | Somerville, MA 02144-2705 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2022 |
Last Update Date | 01/02/2022 |