Individual
JENNIFER HYDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OPTICIAN
Contact information
Practice address
495 WESTERN AVE, BRIGHTON, MA 02135-1007
(161) 787-0743
Mailing address
495 WESTERN AVE, BRIGHTON, MA 02135-1007
(617) 783-0500
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
6636
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1487664884
—
MA
01
—
148766884
OPTICIAN
MA
Enumeration date
04/19/2018
Last updated
04/19/2018
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