Provider Demographics
NPI:1720314644
Name:LUNETTE DEDHAM, PC
Entity Type:Organization
Organization Name:LUNETTE DEDHAM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHIMIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-407-9600
Mailing Address - Street 1:241 PERKINS ST
Mailing Address - Street 2:#F101
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-4002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:241 PERKINS ST
Practice Address - Street 2:#F101
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-4002
Practice Address - Country:US
Practice Address - Phone:781-407-9600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4140152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty