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General NPI Number Information
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NPI Number | 1609044361
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Entity Type | Organization
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Legal Business Name | RICHARD L. JASIAK O.D.,P.C.
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Dates
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Enumeration Date | 02/15/2008
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Last Update Date | 04/29/2008
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Provider Practice Location Address
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Address Line | 1 PARK WAY
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City | HAVERHILL
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State | MA
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Zip | 01830-6278
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Country | US
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Telephone | 978-374-2010
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Fax |
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Provider Business Mailing Address
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Address Line | 1 PARK WAY
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City | HAVERHILL
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State | MA
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Zip | 01830-6278
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Country | US
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Telephone | 978-374-2010
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD JASIAK
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Credential | O.D.
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Telephone | 978-374-2010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 3157
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License Number State | MA
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