Organization
CANNON FAMILY EYECARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARI CANNON OD (OWNER)
(617) 323-0200
Entity
Organization
Contact information
Practice address
1819 CENTRE ST, WEST ROXBURY, MA 02132-1945
(617) 323-0200
Mailing address
1819 CENTRE ST, WEST ROXBURY, MA 02132-1945
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
648830
TUFTS
—
01
—
W20417
BCBS
MA
Enumeration date
02/09/2007
Last updated
08/01/2007
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