Provider Demographics
NPI:1093788242
Name:HERRON, DAVID JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOHN
Last Name:HERRON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 GRANITE ST
Mailing Address - Street 2:SUITE 2069
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-2804
Mailing Address - Country:US
Mailing Address - Phone:781-849-9944
Mailing Address - Fax:781-848-1023
Practice Address - Street 1:250 GRANITE ST
Practice Address - Street 2:SUITE 2069
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-2804
Practice Address - Country:US
Practice Address - Phone:781-849-9944
Practice Address - Fax:781-848-1023
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA3190152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW15730OtherBCBS
MA0353086Medicaid
MA150936OtherHARVARD HMO
MA763496OtherTUFTS HMO
MAB20925201OtherCIGNA
MA08474OtherAETNA
MA2200359OtherUNITED HEALTH CARE
MAMA3190OtherEYEMED
MAT92992Medicare UPIN
MA08474OtherAETNA