=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851867733
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGELA SANCHEZ LDO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2018
-----------------------------------------------------
Last Update Date | 10/18/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 EVERETT AVE
-----------------------------------------------------
City | CHELSEA
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02150-2385
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-884-0456
-----------------------------------------------------
Fax | 671-884-0457
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7 BARR RD
-----------------------------------------------------
City | PEABODY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01960-4609
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-587-1397
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 156FX1800X
-----------------------------------------------------
Taxonomy Name | Optician
-----------------------------------------------------
License Number | 6605
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------