Provider Demographics
NPI:1841034808
Name:WASZ, ALLISON DIANE
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:DIANE
Last Name:WASZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 SPRING ST STE 2
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-3400
Mailing Address - Country:US
Mailing Address - Phone:617-924-3343
Mailing Address - Fax:617-926-6634
Practice Address - Street 1:31 SPRING ST STE 2
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-3400
Practice Address - Country:US
Practice Address - Phone:617-924-3343
Practice Address - Fax:617-926-6634
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAOPT5733152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist