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General NPI Number Information
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NPI Number | 1649458209
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Entity Type | Individual
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Provider Name | EWA M. MAMBER O.D.
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Gender | Female
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Dates
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Enumeration Date | 02/06/2008
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Last Update Date | 02/06/2008
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Provider Practice Location Address
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Address Line | WESTBOROUGH STATE HOSPITAL LYMAN STREET
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City | WESTBOROUGH
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State | MA
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Zip | 01581-0288
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Country | US
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Telephone | 508-616-2835
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 288 WESTBOROUGH STATE HOSPITAL
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City | WESTBOROUGH
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State | MA
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Zip | 01581-0288
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Country | US
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Telephone | 508-616-2835
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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 | 3203
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License Number State | MA
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