Individual
DR. MICHAEL K EDELSTEIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
446 MOODY ST, WALTHAM, MA 02453-0415
(781) 899-3200
(781) 894-4645
Mailing address
PO BOX 789, LUDLOW, MA 01056-0789
(413) 509-1000
(413) 509-1003
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2402
MA
152W00000X
Optometrist
2402TP
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0322121
—
MA
01
—
W16223
BLUE CROSS
MA
Enumeration date
12/20/2005
Last updated
04/02/2008
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