Healthcare Provider Details

I. General information

NPI: 1487108585
Provider Name (Legal Business Name): ALINA REZNIK O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2016
Last Update Date: 07/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 ARCH ST FL 16
BOSTON MA
02110-1424
US

IV. Provider business mailing address

33 ARCH ST FL 16
BOSTON MA
02110-1424
US

V. Phone/Fax

Practice location:
  • Phone: 617-356-8117
  • Fax: 617-249-0621
Mailing address:
  • Phone: 617-356-8117
  • Fax: 617-249-0621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5152
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: