Healthcare Provider Details

I. General information

NPI: 1073361994
Provider Name (Legal Business Name): ANASTASIA LOGOTHETI OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2024
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 HARRISON AVE # ACC-3
BOSTON MA
02118-4001
US

IV. Provider business mailing address

850 HARRISON AVE # ACC-3
BOSTON MA
02118-4001
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-4020
  • Fax: 617-414-4028
Mailing address:
  • Phone: 617-414-4020
  • Fax: 617-414-4028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT8279
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: