Healthcare Provider Details

I. General information

NPI: 1952680209
Provider Name (Legal Business Name): MARY-ANN ZAPPALA O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY-ANN ECMECIAN O.D.

II. Dates (important events)

Enumeration Date: 08/04/2011
Last Update Date: 01/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 HARVARD ST
BROOKLINE MA
02445-7904
US

IV. Provider business mailing address

11 HARVARD ST
BROOKLINE MA
02445-7904
US

V. Phone/Fax

Practice location:
  • Phone: 617-734-7171
  • Fax: 573-371-0748
Mailing address:
  • Phone: 617-734-7171
  • Fax: 857-337-1074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4876
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: