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General NPI Number Information
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NPI Number | 1265597439
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Entity Type | Individual
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Provider Name | DAVID TIERNEY OD
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Gender | Male
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 06/08/2011
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Provider Practice Location Address
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Address Line | 40 HOLLAND ST
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City | SOMERVILLE
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State | MA
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Zip | 02144-2705
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Country | US
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Telephone | 617-629-6280
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Fax | 617-629-6275
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Provider Business Mailing Address
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Address Line | 147 MILK ST
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City | BOSTON
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State | MA
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Zip | 02109-4806
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 3316
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License Number State | MA
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