Healthcare Provider Details

I. General information

NPI: 1558301663
Provider Name (Legal Business Name): NYLA ANN LAMBERT O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 12/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 SALEM ST SUITE 7
GROVELAND MA
01834-1565
US

IV. Provider business mailing address

939 SALEM ST SUITE 7
GROVELAND MA
01834-1565
US

V. Phone/Fax

Practice location:
  • Phone: 978-374-8991
  • Fax: 978-373-7852
Mailing address:
  • Phone: 978-374-8991
  • Fax: 978-373-7852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4306
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: