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General NPI Number Information
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NPI Number | 1851443493
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Entity Type | Individual
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Provider Name | DONALD ROY KORB OD
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Gender | Male
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 02/29/2012
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Provider Practice Location Address
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Address Line | 400 COMMONWEALTH AVE UNIT 2
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City | BOSTON
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State | MA
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Zip | 02215
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Country | US
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Telephone | 617-426-0370
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Fax | 617-426-4924
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Provider Business Mailing Address
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Address Line | 400 COMMONWEALTH AVENUE UNIT 2
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City | BOSTON
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State | MA
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Zip | 02215
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Country | US
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Telephone | 617-426-0370
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Fax | 617-426-4924
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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 | 2019
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License Number State | MA
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