Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 5810 | MA |
NPI | 1124222336 |
---|---|
Provider Name | Mrs. Cynthia Louise Daigneault |
First Address | Wrentham, MA 02093-1006 |
Second Address | Wrentham, MA 02093-1006 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0720194 | (05) | MA |