Healthcare Provider Details

I. General information

NPI: 1659835528
Provider Name (Legal Business Name): DAMYANOVA EYE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2019
Last Update Date: 08/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 LYNNWAY
LYNN MA
01905-3028
US

IV. Provider business mailing address

427 LYNNWAY
LYNN MA
01905-3028
US

V. Phone/Fax

Practice location:
  • Phone: 781-598-2773
  • Fax:
Mailing address:
  • Phone: 781-599-2773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State

VIII. Authorized Official

Name: PETYA DAMYNOVA
Title or Position: OPTOMETRIST
Credential:
Phone: 617-771-6097