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General NPI Number Information
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NPI Number | 1396664157
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Entity Type | Organization
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Legal Business Name | MAVERICK SQ OPTICAL
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Dates
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Enumeration Date | 07/14/2026
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Last Update Date | 07/14/2026
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Provider Practice Location Address
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Address Line | 230 MERIDIAN ST
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City | BOSTON
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State | MA
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Zip | 02128-1654
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Country | US
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Telephone | 978-394-6433
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Fax |
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Provider Business Mailing Address
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Address Line | 5 RANDALL RD
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City | PEABODY
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State | MA
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Zip | 01960-1211
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Country | US
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Telephone | 978-394-6433
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTOPHER SURIEL-TAVAREZ
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Credential |
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Telephone | 978-394-6433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State |
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