MEDICARE: DR. ROBERT ARNOLD BUONFIGLIO 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	2889	MA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	W17306	OTHER	MA	MEDICARE PTAN

General Provider Information

NPI Number	:	1518966498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT ARNOLD BUONFIGLIO O.D.

Provider Business Mailing Address
First Line	:	200 WALNUT ST
Second Line	:
City	:	SAUGUS
State	:	MA
Zip	:	01906-1158
Country	:	US
Telephone Number	:	781-231-1100
Fax Number	:	781-231-9634

Provider Business Practice Location Address
First Line	:	200 WALNUT ST
Second Line	:
City	:	SAUGUS
State	:	MA
Zip	:	01906-1158
Country	:	US
Telephone Number	:	781-231-1100
Fax Number	:	781-231-9634

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

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	09/23/2008

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