Healthcare Provider Details

I. General information

NPI: 1750332839
Provider Name (Legal Business Name): ELIZABETH J.S. REDMAN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 01/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 WASHINGTON ST STE 3 MASS OPTOMETRIC ASSOCIATES, P.C.
PEMBROKE MA
02359-1887
US

IV. Provider business mailing address

2921 ERIE BLVD E C/O EMPIRE VISION CENTER, INC
SYRACUSE NY
13224-1430
US

V. Phone/Fax

Practice location:
  • Phone: 781-826-5117
  • Fax: 781-826-0954
Mailing address:
  • Phone: 315-445-7465
  • Fax: 315-445-7675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4541
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: