Basic Information
| Provider Information | |||||||||
| NPI: | 1336252956 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TOOLIN | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 940 BELMONT ST | ||||||||
| Address2: | VA BROCKTON EYE CLINIC | ||||||||
| City: | BROCKTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023015596 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085834500 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 940 BELMONT ST | ||||||||
| Address2: | VA BROCKTON EYE CLINIC | ||||||||
| City: | BROCKTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023015596 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085834500 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 4114 | MA | Y | Eye and Vision Services Providers | Optometrist | 152W00000X | 002487 | CT | N | Eye and Vision Services Providers | Optometrist | 152W00000X | ODT00479 | RI | N | Eye and Vision Services Providers | Optometrist |
No ID Information.