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General NPI Number Information
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NPI Number | 1922732684
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Entity Type | Organization
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Legal Business Name | NORTHEAST OPTOMETRY LLC
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Dates
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Enumeration Date | 07/10/2022
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 60 MASSACHUSETTS AVE
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City | ARLINGTON
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State | MA
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Zip | 02474-8621
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Country | US
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Telephone | 781-316-0141
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Fax | 781-394-6107
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Provider Business Mailing Address
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Address Line | 539 CLINTON RD
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City | CHESTNUT HILL
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State | MA
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Zip | 02467-1418
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Country | US
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Telephone |
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Fax | 617-232-2279
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSEPHINE KO
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Credential |
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Telephone | 781-316-0141
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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 |
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License Number State |
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