Provider Demographics
NPI:1043696602
Name:LIVING CLEARLY OPTOMETRY
Entity Type:Organization
Organization Name:LIVING CLEARLY OPTOMETRY
Other - Org Name:DR. TARA L. SULLIVAN, O.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER & OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TARA
Authorized Official - Middle Name:LEANNE
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:781-270-7499
Mailing Address - Street 1:15 NEW ENGLAND EXECUTIVE PARK
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-5202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:74 BURLINGTON MALL ROAD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803
Practice Address - Country:US
Practice Address - Phone:781-272-5620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5072152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty