Jake Duclos Fiore, OD
Optometrist in Waltham, MA. Individual provider (NPI-1).
NPI number1104556232
StatusActive
Last updated in NPPESNov 1, 2022
Details
- NPI
- 1104556232
- Entity type
- Individual (NPI-1)
- Name
- Jake Duclos Fiore
- Credential
- OD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jun 13, 2022
- Certification date
- Oct 21, 2022
- Last updated
- Nov 1, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 152W00000X | Optometrist | 5569 | MA | Yes |
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – |
Practice location
289 Moody StWaltham, MA 02453-5284
Phone 781-894-2127
Mailing address
289 Moody StWaltham, MA 02453-5284
Phone 781-894-2127
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