Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 3099 | MA |
NPI | 1003155813 |
---|---|
Provider Name | Thomas E Bigelow |
First Address | Boston, MA 02111-1552 |
Second Address | Boston, MA 02111-1552 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2013 |
Last Update Date | 14/02/2013 |