Healthcare Provider Details

I. General information

NPI: 1992757272
Provider Name (Legal Business Name): MICHELLE BOLARINHO LICENSED OPTICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 STATE RD
N DARTMOUTH MA
02747-3319
US

IV. Provider business mailing address

51 STATE RD
N DARTMOUTH MA
02747-3319
US

V. Phone/Fax

Practice location:
  • Phone: 508-999-7779
  • Fax: 508-910-2217
Mailing address:
  • Phone: 508-999-7779
  • Fax: 508-910-2217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number4839
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: