Individual
MR. SAMUEL POLANCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
327 ESSEX ST, VISION OPTICAL, LAWRENCE, MA 01840
(978) 689-4402
Mailing address
327 ESSEX ST, LAWRENCE, MA 01840
(978) 689-4402
(978) 688-5890
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
4228
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1526014
—
MA
Enumeration date
04/20/2007
Last updated
07/08/2007
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