Provider Demographics
NPI:1295826287
Name:JAMARA, RICHARD J (OD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:JAMARA
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 1:12 GALLAGHER DR
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-5240
Mailing Address - Country:US
Mailing Address - Phone:617-236-6291
Mailing Address - Fax:617-424-9202
Practice Address - Street 1:12 GALLAGHER DR
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-5240
Practice Address - Country:US
Practice Address - Phone:781-986-7558
Practice Address - Fax:781-986-7558
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2874152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA709616OtherTUFTS
MA000000022616OtherBMC HEALTHNET
MAS022123OtherTRICARE
MA0023814OtherNHP
MAAA21586OtherHARVARD PILGRIM
MA0353108Medicaid
MAW15641OtherBLUE CROSS BLUE SHIELD
MAAA21586OtherHARVARD PILGRIM
MA0353108Medicaid