Individual
DR. ELAINE ICBAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
4199 WASHINGTON ST, SUITE 2, BOSTON, MA 02131-1733
(617) 587-5520
(617) 587-5521
Mailing address
930 COMMONWEALTH AVE, SUITE 2A, BOSTON, MA 02215-1274
(617) 587-5511
(617) 587-5514
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4677
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2988926
UNITED HEALTH CARE
MA
01
—
7733882
AETNA
MA
01
—
95191001
NETWORK HEALTH
MA
01
—
AA131399
HARVARD PILGRIM
MA
Enumeration date
06/04/2006
Last updated
03/05/2009
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