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General NPI Number Information
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NPI Number | 1306514633
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Entity Type | Organization
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Legal Business Name | JONATHAN R PENA OD PC
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Dates
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Enumeration Date | 09/01/2021
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Last Update Date | 09/01/2021
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Provider Practice Location Address
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Address Line | 495 MASSACHUSETTS AVE
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City | CAMBRIDGE
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State | MA
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Zip | 02139-4018
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Country | US
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Telephone | 617-354-3600
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Fax | 617-812-8257
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Provider Business Mailing Address
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Address Line | 278 BARKER ST
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City | NORTH ANDOVER
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State | MA
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Zip | 01845-1123
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Country | US
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Telephone | 920-287-9866
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | JONATHAN R PENA
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Credential | OD
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Telephone | 920-287-9866
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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 |
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License Number State |
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