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General NPI Number Information
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NPI Number | 1578815528
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Entity Type | Organization
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Legal Business Name | MODDERNO EYECARE, P.C.
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Dates
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Enumeration Date | 10/15/2012
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Last Update Date | 10/15/2012
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Provider Practice Location Address
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Address Line | 138 NAHATAN ST
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City | NORWOOD
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State | MA
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Zip | 02062-4252
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Country | US
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Telephone | 781-255-1505
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Fax | 781-255-1507
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Provider Business Mailing Address
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Address Line | 138 NAHATAN ST
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City | NORWOOD
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State | MA
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Zip | 02062-4252
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Country | US
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Telephone | 781-255-1505
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Fax | 781-255-1507
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MATTHEW JOSEPH MODDERNO
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Credential | O.D.
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Telephone | 781-255-1505
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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 | 4353
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License Number State | MA
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