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NPI Code Detail

MEDICARE: AILEEN MARIA OD

MEDICARE: AILEEN MARIA OD
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
1152W00000XOptometrist4319MA
2152W00000XOptometrist0743NH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1083697353
Entity Type Code : Individual
Provider Name (Legal Business Name) : AILEEN MARIA OD
Provider Business Mailing Address
First Line : 360 MERRIMACK ST
Second Line : BLDG 9
City : LAWRENCE
State : MA
Zip : 01843-1740
Country : US
Telephone Number : 978-688-6182
Fax Number : 978-689-0731
Provider Business Practice Location Address
First Line : 360 MERRIMACK ST
Second Line : BLDG 9
City : LAWRENCE
State : MA
Zip : 01843-1740
Country : US
Telephone Number : 978-688-6182
Fax Number : 978-689-0731
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2005
Last Update Date : 09/25/2021

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1366425639 — CYNTHIA L DEANGELIS M.D.
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Directions to “ AILEEN MARIA OD” Practice Location

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