Provider Demographics
NPI:1497773790
Name:RAPOPORT, ALAN M (OD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:M
Last Name:RAPOPORT
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 1:537 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-3001
Mailing Address - Country:US
Mailing Address - Phone:781-828-0656
Mailing Address - Fax:781-828-0775
Practice Address - Street 1:537 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-3001
Practice Address - Country:US
Practice Address - Phone:781-828-0656
Practice Address - Fax:781-828-0775
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3255152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0354457Medicaid
MA150864OtherHARVARD PILGRIM
MAW15754OtherBC/BS
MAT59409Medicare UPIN
MA409058Medicare PIN