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General NPI Number Information
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NPI Number | 1467604520
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Entity Type | Individual
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Provider Name | JENNIFER VELASCO BADIOLA O.D.
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Gender | Female
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 138 HAVERHILL ST STE 104
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City | ANDOVER
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State | MA
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Zip | 01810-1501
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Country | US
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Telephone | 978-475-0705
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Fax |
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Provider Business Mailing Address
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Address Line | 4 WALLACE RD
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City | LYNN
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State | MA
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Zip | 01902-2012
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Country | US
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Telephone | 617-396-4056
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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 | OPT5708
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License Number State | MA
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