Provider Demographics
NPI:1073361994
Name:LOGOTHETI, ANASTASIA (OD)
Entity type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:
Last Name:LOGOTHETI
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 1:850 HARRISON AVE # ACC-3
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-4001
Mailing Address - Country:US
Mailing Address - Phone:617-414-4020
Mailing Address - Fax:617-414-4028
Practice Address - Street 1:850 HARRISON AVE # ACC-3
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-4001
Practice Address - Country:US
Practice Address - Phone:617-414-4020
Practice Address - Fax:617-414-4028
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-07
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAOPT8279152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist