Individual
BOBIN G NICHOLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OPTICIAN
Contact information
Practice address
133 BROOKLINE AVE, BOSTON, MA 02215-3904
(617) 421-1000
(617) 421-6084
Mailing address
147 MILK ST, PROVIDER ENROLLMENT DEPARTMENT 9TH FLOOR, BOSTON, MA 02109-4806
(617) 421-2508
(617) 421-3487
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
4972
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0324345
—
MA
Enumeration date
04/25/2007
Last updated
07/08/2007
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