Basic Information
Provider Information
NPI: 1003800749
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TOWNSEND
FirstName: DANIEL
MiddleName: J
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 340 MAIN ST
Address2: SUITE 670
City: WORCESTER
State: MA
PostalCode: 016081604
CountryCode: US
TelephoneNumber: 5087543566
FaxNumber: 5087988012
Practice Location
Address1: 175 CAMBRIDGE ST
Address2: C/O PROOPTICAL
City: BOSTON
State: MA
PostalCode: 021142743
CountryCode: US
TelephoneNumber: 6177233937
FaxNumber: 6175235006
Other Information
ProviderEnumerationDate: 09/08/2005
LastUpdateDate: 05/01/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207W00000X48007MAY Allopathic & Osteopathic PhysiciansOphthalmology 

ID Information
IDTypeStateIssuerDescription
617524405MA MEDICAID
J0265301MAFORMER IDOTHER


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