Individual
DIANE MATUCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
19 TACOMA ST, WORCESTER, MA 01605-3516
(508) 852-1805
Mailing address
19 TACOMA ST, WORCESTER, MA 01605-3516
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
5830
MA
Other
Enumeration date
02/08/2010
Last updated
02/08/2010
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