Organization
DR ANTHONY W IRACA OF MEDFORD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTHONY WALTER IRACA JR. OD (PRESIDENT)
(781) 391-1195
Entity
Organization
Contact information
Practice address
4110 MYSTIC VALLEY PARKWAY, MEDFORD, MA 02155
(781) 391-1195
(781) 395-7875
Mailing address
4110 MYSTIC VALLEY PARKWAY, MEDFORD, MA 02155
(781) 391-1195
(781) 395-7875
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3432
MA
152WC0802X
Corneal and Contact Management Optometrist
3432
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W20411
BCBS
MA
Enumeration date
10/10/2007
Last updated
10/10/2007
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