Organization
LICKTEIG FAMILY EYECARE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BENJAMIN THOMAS LICKTEIG O.D. (OWNER)
(781) 329-0067
Entity
Organization
Contact information
Practice address
870 PROVIDENCE HWY, DEDHAM, MA 02026-6806
(781) 329-0067
(781) 320-5603
Mailing address
870 PROVIDENCE HWY, DEDHAM, MA 02026-6806
(781) 329-0067
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4782
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0019618
MEDICARE PTAN
MA
Enumeration date
09/20/2010
Last updated
06/13/2011
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