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General NPI Number Information
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NPI Number | 1730374927
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Entity Type | Organization
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Legal Business Name | BRAINTREE VISION ASSOCIATES
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Dates
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Enumeration Date | 09/11/2007
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Last Update Date | 09/11/2007
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Provider Practice Location Address
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Address Line | 120 BAY STATE DR
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City | BRAINTREE
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State | MA
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Zip | 02184-5205
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Country | US
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Telephone | 781-848-2020
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Fax | 781-848-7230
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Provider Business Mailing Address
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Address Line | 120 BAY STATE DR
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City | BRAINTREE
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State | MA
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Zip | 02184-5205
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Country | US
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Telephone | 781-848-2020
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Fax | 781-848-7230
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. FREDERICK R VALENTINE JR.
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Credential | O.D.
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Telephone | 781-848-2020
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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 | 2613
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License Number State | MA
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