Healthcare Provider Details

I. General information

NPI: 1205906104
Provider Name (Legal Business Name): CHANTAL DOLLY MCCARRON O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 WOODLAND RD SUITE 120
STONEHAM MA
02180-1702
US

IV. Provider business mailing address

3 WOODLAND RD SUITE 120
STONEHAM MA
02180-1702
US

V. Phone/Fax

Practice location:
  • Phone: 781-979-0960
  • Fax: 781-979-0618
Mailing address:
  • Phone: 781-979-0960
  • Fax: 781-979-0618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG003638
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618002841
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number21309-875
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC4074
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number007646
License Number StateNY
# 6
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4674
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: