Healthcare Provider Details

I. General information

NPI: 1104592930
Provider Name (Legal Business Name): JONATHAN PARRELLI LDO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2021
Last Update Date: 08/20/2021
Certification Date: 08/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 ELM ST
DANVERS MA
01923-2835
US

IV. Provider business mailing address

35 ELM ST
DANVERS MA
01923-2835
US

V. Phone/Fax

Practice location:
  • Phone: 978-777-0379
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FC0801X
TaxonomyContact Lens Fitter
License NumberMA5553
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberMA5553
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: