Provider Demographics
NPI:1649458209
Name:MAMBER, EWA M (OD)
Entity type:Individual
Prefix:
First Name:EWA
Middle Name:M
Last Name:MAMBER
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:PO BOX 288
Mailing Address - Street 2:WESTBOROUGH STATE HOSPITAL
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-0288
Mailing Address - Country:US
Mailing Address - Phone:508-616-2835
Mailing Address - Fax:
Practice Address - Street 1:WESTBOROUGH STATE HOSPITAL
Practice Address - Street 2:LYMAN STREET
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-0288
Practice Address - Country:US
Practice Address - Phone:508-616-2835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3203152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist