Organization
MEDFORD EYEGLASS SHOP INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICCARDO L BUZZANGA RDO (OPTICIAN)
(781) 391-4069
Entity
Organization
Contact information
Practice address
466 SALEM ST, MEDFORD, MA 02155-3343
(781) 391-4069
Mailing address
466 SALEM ST, MEDFORD, MA 02155-3343
(781) 391-4069
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
4427
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1512005
—
MA
Enumeration date
04/09/2007
Last updated
08/14/2007
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