Provider Demographics
NPI:1609935725
Name:D'AMIANO, ELISE (OD)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:D'AMIANO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 ALDEN RD
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-3729
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6 W MILL ST FL 1
Practice Address - Street 2:
Practice Address - City:MEDFIELD
Practice Address - State:MA
Practice Address - Zip Code:02052-1507
Practice Address - Country:US
Practice Address - Phone:508-359-4164
Practice Address - Fax:508-359-2860
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3708152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110013238AMedicaid
759055OtherTUFTS
2258529OtherCIGNA
22-00448OtherUNITED
W15980OtherBCBS
AA15548OtherHPHC
W15980OtherBCBS
MA0313734Medicaid