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General NPI Number Information
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NPI Number | 1871680298
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Entity Type | Individual
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Provider Name | ROSE MARY REDMOND OD
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Gender | Female
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4110 MYSTIC VALLEY PKWY WELLINGTON CIRCLE PLAZA
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City | MEDFORD
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State | MA
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Zip | 02155-6931
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Country | US
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Telephone | 781-391-1195
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Fax |
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Provider Business Mailing Address
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Address Line | 15 MARION AVENUE
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City | ANDOVER
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State | MA
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Zip | 01810
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Country | US
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Telephone | 978-749-8951
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Fax |
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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 | 639
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3694
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License Number State | MA
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