Individual
DORA PEPO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
200 SPRINGS RD, BEDFORD, MA 01730-1114
(857) 207-7921
Mailing address
72 CUSHING ST APT 2, WALTHAM, MA 02453-0425
(857) 207-7921
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OEG003567
PA
Other
Enumeration date
09/04/2019
Last updated
09/04/2019
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