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General NPI Number Information
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NPI Number | 1326322645
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Entity Type | Individual
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Provider Name | LILY NG O.D.
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Gender | Female
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Dates
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Enumeration Date | 10/05/2011
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Last Update Date | 01/31/2014
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Provider Practice Location Address
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Address Line | 250 GRANITE ST SEARS OPTICAL
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City | BRAINTREE
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State | MA
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Zip | 02184-2804
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Country | US
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Telephone | 781-843-4295
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Fax | 781-848-4868
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Provider Business Mailing Address
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Address Line | 758 TREMONT ST APT 1
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City | BOSTON
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State | MA
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Zip | 02118-1105
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Country | US
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Telephone | 781-985-0398
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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 | 4866
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License Number State | MA
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