Provider Demographics
NPI:1093082794
Name:HELEN FARJAD
Entity Type:Organization
Organization Name:HELEN FARJAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FARJAD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:617-309-0111
Mailing Address - Street 1:9211 STATION CIR
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-4592
Mailing Address - Country:US
Mailing Address - Phone:781-329-4514
Mailing Address - Fax:508-484-2008
Practice Address - Street 1:9211 STATION CIR
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-4592
Practice Address - Country:US
Practice Address - Phone:781-329-4514
Practice Address - Fax:508-484-2008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-23
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4733152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty