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General NPI Number Information
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NPI Number | 1619029550
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Entity Type | Organization
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Legal Business Name | INDEPENDENT EYE CARE INC
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 01/30/2017
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Provider Practice Location Address
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Address Line | 180 ENDICOTT ST
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City | DANVERS
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State | MA
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Zip | 01923-3683
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Country | US
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Telephone | 508-880-0793
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Fax |
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Provider Business Mailing Address
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Address Line | 180 ENDICOTT ST
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City | DANVERS
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State | MA
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Zip | 01923-3683
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Country | US
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Telephone | 508-880-0793
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHN IANNITTO
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Credential | OD
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Telephone | 978-774-4500
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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 |
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License Number State |
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