Healthcare Provider Details

I. General information

NPI: 1629153994
Provider Name (Legal Business Name): TALAMO HATCH LASER EYE CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 08/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 TRAPELO RD SUITE 184
WALTHAM MA
02451-7333
US

IV. Provider business mailing address

1601 TRAPELO RD SUITE 184
WALTHAM MA
02451-7333
US

V. Phone/Fax

Practice location:
  • Phone: 781-890-1023
  • Fax: 781-890-2507
Mailing address:
  • Phone: 781-890-1023
  • Fax: 781-890-2507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number72615
License Number StateMA

VIII. Authorized Official

Name: DR. JONATHAN H. TALAMO
Title or Position: OWNER
Credential: MD.
Phone: 781-890-1023