MEDICARE: DR. LINDA A. WIRTH O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	3562	MA

General Provider Information

NPI Number	:	1063537553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINDA A. WIRTH O.D.

Provider Business Mailing Address
First Line	:	2 WHITING RD
Second Line	:	PO BOX 246
City	:	DOVER
State	:	MA
Zip	:	02030-2451
Country	:	US
Telephone Number	:	508-785-1770
Fax Number	:	508-785-1770

Provider Business Practice Location Address
First Line	:	2 WHITING ROAD
Second Line	:
City	:	DOVER
State	:	MA
Zip	:	02030-2374
Country	:	US
Telephone Number	:	508-785-1770
Fax Number	:	508-785-1770

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	04/28/2011

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