Healthcare Provider Details

I. General information

NPI: 1508328774
Provider Name (Legal Business Name): AMRIT K JAWANDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2019
Last Update Date: 07/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 COMMONWEALTH AVE
BOSTON MA
02215-1200
US

IV. Provider business mailing address

930 COMMONWEALTH AVE STE 1
BOSTON MA
02215-1274
US

V. Phone/Fax

Practice location:
  • Phone: 617-262-2020
  • Fax:
Mailing address:
  • Phone: 617-262-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number10271992
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: