Healthcare Provider Details

I. General information

NPI: 1609982677
Provider Name (Legal Business Name): ROSELYN WEI GWEN JEUN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 05/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 WASHINGTON STREET
HOLLISTON MA
01746
US

IV. Provider business mailing address

841 WASHINGTON STREET
HOLLISTON MA
01746
US

V. Phone/Fax

Practice location:
  • Phone: 508-429-1330
  • Fax: 508-429-0922
Mailing address:
  • Phone: 508-429-1330
  • Fax: 508-429-0922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number4086
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: