Healthcare Provider Details

I. General information

NPI: 1639178569
Provider Name (Legal Business Name): MARJORIE RAH OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 COMMONWEALTH AVE SUITE 2A NEW ENGLAND EYE INSTITUTE
BOSTON MA
02215
US

IV. Provider business mailing address

930 COMMONWEALTH AVE SUITE 2A NEW ENGLAND EYE INSTITUTE
BOSTON MA
02215
US

V. Phone/Fax

Practice location:
  • Phone: 617-262-2020
  • Fax: 617-236-6323
Mailing address:
  • Phone: 617-262-2020
  • Fax: 617-236-6323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4237
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: