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General NPI Number Information
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NPI Number | 1184819518
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Entity Type | Organization
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Legal Business Name | LEA OPTOMETRIC. PC
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Dates
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Enumeration Date | 09/10/2007
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Last Update Date | 09/10/2007
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Provider Practice Location Address
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Address Line | 28 STATE ST
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City | NEWBURYPORT
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State | MA
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Zip | 01950-6605
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Country | US
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Telephone | 978-465-2405
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Fax | 978-463-4377
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Provider Business Mailing Address
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Address Line | 28 STATE ST
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City | NEWBURYPORT
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State | MA
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Zip | 01950-6605
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Country | US
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Telephone | 978-465-2405
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Fax | 978-463-4377
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Authorized Official
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Title or Position | OWNER
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Name | LAUREN K MCLOUGHLIN
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Credential | OD
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Telephone | 978-465-2405
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4411
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3780
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4245
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License Number State | MA
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