Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 4158 | MA |
NPI | 1104967082 |
---|---|
Provider Name | Ms. Sheila Lawler |
First Address | Boston, MA 02215-1274 |
Second Address | Boston, MA 02215-1274 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0702331 | (05) | MA |