Healthcare Provider Details

I. General information

NPI: 1144383472
Provider Name (Legal Business Name): JOAN MARIE EXFORD OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOAN MARIE KORB OD

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 COMMONWEALTH AVE UNIT 2
BOSTON MA
02215
US

IV. Provider business mailing address

400 COMMONWEALTH AVE UNIT 2
BOSTON MA
02215
US

V. Phone/Fax

Practice location:
  • Phone: 617-426-0370
  • Fax: 617-426-4924
Mailing address:
  • Phone: 617-426-0370
  • Fax: 617-426-4924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2129
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: