Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 6080 | MA |
NPI | 1184864670 |
---|---|
Provider Name | Mrs. Yelena Volnova |
First Address | Dedham, MA 02026-1804 |
Second Address | Dedham, MA 02026-1804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2009 |
Last Update Date | 24/02/2009 |