Provider Demographics
NPI:1144383472
Name:EXFORD, JOAN MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:MARIE
Last Name:EXFORD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JOAN
Other - Middle Name:MARIE
Other - Last Name:KORB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:400 COMMONWEALTH AVE
Mailing Address - Street 2:UNIT 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215
Mailing Address - Country:US
Mailing Address - Phone:617-426-0370
Mailing Address - Fax:617-426-4924
Practice Address - Street 1:400 COMMONWEALTH AVE
Practice Address - Street 2:UNIT 2
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:617-426-0370
Practice Address - Fax:617-426-4924
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2129152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
152088OtherHARVARD PILGRIM HEALTHCAR
2257205OtherAETNA HEALTHCARE
MAW16072OtherBCBS MA
MA0308714Medicaid
2200596OtherUNITED HEALTHCARE
MA759106OtherTUFTS HEALTH PLAN
042304182OtherVISION SERVICE PLAN
2129OtherVISION BENEFITS OF AMERIC
39436002OtherDAVIS VISION EYECARE
MAEXW17273Medicare ID - Type Unspecified
MA0308714Medicaid