Healthcare Provider Details

I. General information

NPI: 1114981974
Provider Name (Legal Business Name): CYNTHIA D'AURIA O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 WASHINGTON ST # 450
BOSTON MA
02111-1526
US

IV. Provider business mailing address

321 WINCHESTER ST
NEWTON MA
02461-2020
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-4600
  • Fax: 617-636-4866
Mailing address:
  • Phone: 617-969-9431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3193
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: