Individual
GRACE E ANOSIKE
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
79 WINTER ST, CAMBRIDGE, MA 02141-1231
(617) 905-8943
Mailing address
79 WINTER ST, CAMBRIDGE, MA 02141-1231
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3941
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0369802
—
MA
Enumeration date
06/18/2006
Last updated
07/08/2007
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