Provider Demographics
NPI:1952700395
Name:CORREIA, VERONICA (RDO)
Entity Type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:
Last Name:CORREIA
Suffix:
Gender:F
Credentials:RDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4199 WASHINGTON ST
Mailing Address - Street 2:SUIT 2
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-1733
Mailing Address - Country:US
Mailing Address - Phone:617-587-5520
Mailing Address - Fax:617-587-5521
Practice Address - Street 1:4199 WASHINGTON ST
Practice Address - Street 2:SUIT 2
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-1733
Practice Address - Country:US
Practice Address - Phone:617-587-5520
Practice Address - Fax:617-587-5521
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6232156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician