Healthcare Provider Details

I. General information

NPI: 1235312729
Provider Name (Legal Business Name): CAROLANN SPERANZO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2007
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1147 HANCOCK ST
QUINCY MA
02169-4343
US

IV. Provider business mailing address

1147 HANCOCK ST
QUINCY MA
02169-4343
US

V. Phone/Fax

Practice location:
  • Phone: 617-773-1178
  • Fax:
Mailing address:
  • Phone: 617-773-1178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1701
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number1701
License Number StateMA

VIII. Authorized Official

Name: MS. CAROLANN MARIE SPERANZO
Title or Position: OWNER
Credential: RDO
Phone: 617-773-1178