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NPI Profile for MARK T DONOVAN in SOUTH BOSTON, MA.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Optician |
156FX1800X | 96[5] | Optician |
| NPI # | 1568736775 |
|
| Status | Active | |
| Credentials | ||
| Entity | Individual | |
| Enumeration date | 03/06/2012 | |
| Last updated | 03/06/2012 - About 14 years ago | |
| Sole proprietor 1 | Yes | |
| Identifiers |
|
|
| Hospital affiliation(s) | Not Available |
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MARK T DONOVAN
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MARK T DONOVAN