Provider Demographics
NPI:1740363399
Name:FARRA, TALINE (OD)
Entity type:Individual
Prefix:DR
First Name:TALINE
Middle Name:
Last Name:FARRA
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 1:647 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-1503
Mailing Address - Country:US
Mailing Address - Phone:617-269-9465
Mailing Address - Fax:
Practice Address - Street 1:647 E BROADWAY
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127-1503
Practice Address - Country:US
Practice Address - Phone:617-823-7534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4097152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA152831OtherHARVARD PILGRIM HEALTH
MAW16308OtherBLUE CROSS BLUE SHEILD
MA0014570OtherNEIGHBORHOOD HEALTH PLAN
MA22-00932OtherUNITED HEALTH CARE
MA38156OtherUNICARE
MAU84337Medicare UPIN
MA38156OtherUNICARE