| NPI | 1649504432 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY EARL PRUDHOMME Manager/Owner 617-448-9295 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CT ct002725) |
| Enumeration Date | 2009-09-25 |
| Last Update Date | 2016-03-14 |