Provider Demographics
NPI:1962523795
Name:CRONIN, BRENDA (OD)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:
Last Name:CRONIN
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 1:63 FAIRMONT ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-8717
Mailing Address - Country:US
Mailing Address - Phone:617-354-5590
Mailing Address - Fax:617-812-6050
Practice Address - Street 1:19 DUNSTER ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5002
Practice Address - Country:US
Practice Address - Phone:617-354-5590
Practice Address - Fax:617-812-6050
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3479152W00000X, 152WC0802X, 152WP0200X, 152WS0006X, 152WX0102X, 156FC0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Not Answered152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Not Answered152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Not Answered152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Not Answered156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens Fitter