Individual
MR. MARK THOMAS DONOVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
666 E BROADWAY, SOUTH BOSTON, MA 02127-1502
(617) 239-4354
(617) 268-2805
Mailing address
666 E BROADWAY, SOUTH BOSTON, MA 02127-1502
(617) 239-4354
(617) 268-2805
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
4282
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03149
SPECTRA
MA
01
—
35531
DAVIS
MA
01
—
A08896
EYEMED
MA
Enumeration date
03/06/2012
Last updated
03/06/2012
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