Provider Demographics
NPI:1235649955
Name:LINNA, NICKOLAS (DO)
Entity Type:Individual
Prefix:
First Name:NICKOLAS
Middle Name:
Last Name:LINNA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-2527
Mailing Address - Country:US
Mailing Address - Phone:413-887-1797
Mailing Address - Fax:
Practice Address - Street 1:120 EAST ST
Practice Address - Street 2:
Practice Address - City:LUDLOW
Practice Address - State:MA
Practice Address - Zip Code:01056-3409
Practice Address - Country:US
Practice Address - Phone:413-887-1797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-08
Last Update Date:2017-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6100171W00000X, 156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No171W00000XOther Service ProvidersContractor