Provider Demographics
NPI:1740369537
Name:BOONSIRISERMSOOK, SIRI (OD)
Entity type:Individual
Prefix:
First Name:SIRI
Middle Name:
Last Name:BOONSIRISERMSOOK
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 1:75 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-3305
Mailing Address - Country:US
Mailing Address - Phone:781-438-3372
Mailing Address - Fax:
Practice Address - Street 1:75 MAIN ST
Practice Address - Street 2:
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-3305
Practice Address - Country:US
Practice Address - Phone:781-438-3372
Practice Address - Fax:781-438-3050
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4307152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMA4307OtherEYE MED VISION CARE
MA7614498OtherAETNA PROVIDER NUMBER
MAAA29247OtherHARVARD PILGRIM
MAW16362OtherBLUE CROSS BLUE SHIELD
MAAA29247OtherHARVARD PILGRIM
MA7614498OtherAETNA PROVIDER NUMBER