Provider Demographics
NPI:1518213370
Name:ROITER, DANA M (OD)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:M
Last Name:ROITER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:M
Other - Last Name:BASTARACHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:50 STANIFORD ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2517
Mailing Address - Country:US
Mailing Address - Phone:617-314-2689
Mailing Address - Fax:617-573-1065
Practice Address - Street 1:195 WEST ST FL 1
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-1111
Practice Address - Country:US
Practice Address - Phone:781-487-2200
Practice Address - Fax:781-487-5717
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4989152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110098060AMedicaid
MAS400125394Medicare PIN
MAS400125393Medicare PIN