Provider Demographics
NPI:1740432889
Name:SHWOM, LEONARD C (RDO)
Entity Type:Individual
Prefix:MR
First Name:LEONARD
Middle Name:C
Last Name:SHWOM
Suffix:
Gender:M
Credentials:RDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:584 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-1807
Mailing Address - Country:US
Mailing Address - Phone:781-471-4337
Mailing Address - Fax:781-471-4339
Practice Address - Street 1:584 HIGH ST
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-1807
Practice Address - Country:US
Practice Address - Phone:781-471-4337
Practice Address - Fax:781-471-4339
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1372332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6212340001Medicare NSC