Basic Information
| Provider Information | |||||||||
| NPI: | 1003155813 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BIGELOW | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | E | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 WASHINGTON ST | ||||||||
| Address2: | BOX 450 | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021111552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176365857 | ||||||||
| FaxNumber: | 6176361264 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 WASHINGTON ST | ||||||||
| Address2: | BOX 450 | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021111552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176365857 | ||||||||
| FaxNumber: | 6176361264 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2013 | ||||||||
| LastUpdateDate: | 02/14/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 156FX1800X | 3099 | MA | Y | Eye and Vision Services Providers | Technician/Technologist | Optician |
No ID Information.