Healthcare Provider Details

I. General information

NPI: 1154980209
Provider Name (Legal Business Name): ADRIAN KOHN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 LINCOLN SQ
WORCESTER MA
01608-1135
US

IV. Provider business mailing address

10 LINCOLN SQ
WORCESTER MA
01608-1135
US

V. Phone/Fax

Practice location:
  • Phone: 508-373-5830
  • Fax: 508-519-5512
Mailing address:
  • Phone: 508-373-5830
  • Fax: 508-519-5512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number0618002770
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3287
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5694
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: