Provider Demographics
NPI:1629037734
Name:CARUSO, JOANNE (OD)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:CARUSO
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 1:235 WAVERLY AVE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-3238
Mailing Address - Country:US
Mailing Address - Phone:617-926-4191
Mailing Address - Fax:617-926-4090
Practice Address - Street 1:235 WAVERLY AVE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-3238
Practice Address - Country:US
Practice Address - Phone:617-926-4191
Practice Address - Fax:617-926-4090
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3209152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0306190001Medicare NSC
MA440158Medicare PIN