Provider Demographics
NPI:1417067547
Name:FONER, MARC ALAN (OD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:ALAN
Last Name:FONER
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 1:167 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-8247
Mailing Address - Country:US
Mailing Address - Phone:508-879-0980
Mailing Address - Fax:508-270-3927
Practice Address - Street 1:167 UNION AVE
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-8247
Practice Address - Country:US
Practice Address - Phone:508-879-0980
Practice Address - Fax:508-270-3927
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3247152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0324001OtherMASS HEALTH
MA712990OtherTUFTS HEALTH CARE
MAW16068OtherBCBS MA.
MA0324001OtherMASS HEALTH
MA712990OtherTUFTS HEALTH CARE