Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 3044 | MA |
NPI | 1013469071 |
---|---|
Provider Name | Philip J Cotter |
First Address | Revere, MA 02151-5305 |
Second Address | Revere, MA 02151-5305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2016 |
Last Update Date | 26/10/2016 |