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General NPI Number Information
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NPI Number | 1659835528
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Entity Type | Organization
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Legal Business Name | DAMYANOVA EYE ASSOCIATES
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Dates
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Enumeration Date | 01/25/2019
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Last Update Date | 08/02/2019
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Provider Practice Location Address
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Address Line | 427 LYNNWAY
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City | LYNN
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State | MA
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Zip | 01905-3028
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Country | US
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Telephone | 781-598-2773
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Fax |
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Provider Business Mailing Address
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Address Line | 427 LYNNWAY
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City | LYNN
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State | MA
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Zip | 01905-3028
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Country | US
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Telephone | 781-599-2773
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | PETYA DAMYNOVA
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Credential |
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Telephone | 617-771-6097
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number |
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License Number State |
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