Healthcare Provider Details

I. General information

NPI: 1831280353
Provider Name (Legal Business Name): ANN KENT-GASIOROWSKI O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 11/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ESSEX CENTER DR
PEABODY MA
01960-2901
US

IV. Provider business mailing address

1 ESSEX CENTER DR
PEABODY MA
01960-2901
US

V. Phone/Fax

Practice location:
  • Phone: 978-538-4400
  • Fax: 978-538-4721
Mailing address:
  • Phone: 978-531-4400
  • Fax: 978-538-4721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3665
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: