Provider Demographics
NPI:1497933121
Name:SCHURGIN, HERBERT L (OD)
Entity Type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:L
Last Name:SCHURGIN
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 1:511 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-3834
Mailing Address - Country:US
Mailing Address - Phone:781-662-9229
Mailing Address - Fax:781-662-1568
Practice Address - Street 1:511 MAIN ST
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-3834
Practice Address - Country:US
Practice Address - Phone:781-662-9229
Practice Address - Fax:781-662-1568
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2123152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0396303Medicaid
MAU30692Medicare UPIN
MA156758Medicare PIN