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General NPI Number Information
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NPI Number | 1700216090
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Entity Type | Organization
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Legal Business Name | ALL EYE CARE AT DAVIS, INC
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Dates
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Enumeration Date | 11/22/2013
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Last Update Date | 11/22/2013
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Provider Practice Location Address
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Address Line | 63 STATION LNDG ATT. DR DZENANA IDRIZOVIC
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City | MEDFORD
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State | MA
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Zip | 02155-5192
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Country | US
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Telephone | 603-566-7463
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Fax |
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Provider Business Mailing Address
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Address Line | 63 STATION LNDG ATT. DR DZENANA IDRIZOVIC
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City | MEDFORD
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State | MA
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Zip | 02155-5192
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Country | US
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Telephone | 603-566-7463
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Fax |
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Authorized Official
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Title or Position | OPTOMETRY DOCTOR
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Name | DR. DZENANA IDRIZOVIC
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Credential | O. D.
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Telephone | 603-566-7463
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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 | 4544
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License Number State | MA
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