Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 6239 | MA |
NPI | 1225581994 |
---|---|
Provider Name | Romelia Ericson |
First Address | Lancaster, MA 01523-3029 |
Second Address | Lancaster, MA 01523-3029 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2016 |
Last Update Date | 29/07/2016 |