Provider Demographics
NPI:1235124389
Name:AGNES, DANA (OD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:
Last Name:AGNES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SUNDAY WOODS RD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:MA
Mailing Address - Zip Code:02493-1249
Mailing Address - Country:US
Mailing Address - Phone:781-907-7723
Mailing Address - Fax:
Practice Address - Street 1:52 2ND AVE STE 2500
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-1252
Practice Address - Country:US
Practice Address - Phone:781-487-2200
Practice Address - Fax:781-487-5717
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1821152W00000X
MA5275152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2471852Medicare ID - Type Unspecified
NCU88414Medicare UPIN