Healthcare Provider Details

I. General information

NPI: 1811833882
Provider Name (Legal Business Name): CHRISTOPHER SURIEL-TAVAREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 MERIDIAN ST
BOSTON MA
02128-1654
US

IV. Provider business mailing address

5 RANDALL RD
PEABODY MA
01960-1211
US

V. Phone/Fax

Practice location:
  • Phone: 978-394-6433
  • Fax:
Mailing address:
  • Phone: 978-394-6433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberDOP100110
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: