Individual
KEVIN DIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
40 ENON ST, BEVERLY, MA 01915-1168
(978) 922-5996
Mailing address
40 ENON ST, BEVERLY, MA 01915-1168
(978) 922-5996
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
4263
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
156FX18004
—
MA
Enumeration date
09/03/2014
Last updated
09/03/2014
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