| NPI | 1689870602 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTINA FAVREAU Office Manager 617-742-7200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA 2665) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MA 2352) |
| Enumeration Date | 2007-06-26 |
| Last Update Date | 2020-08-22 |