Provider Demographics
NPI:1154965580
Name:DR. ROSANNA C. LAMALVA & ASSOCIATES
Entity type:Organization
Organization Name:DR. ROSANNA C. LAMALVA & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSANNA
Authorized Official - Middle Name:C
Authorized Official - Last Name:LAMALVA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:617-523-9700
Mailing Address - Street 1:10 CITY HALL AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02108-4301
Mailing Address - Country:US
Mailing Address - Phone:617-523-9700
Mailing Address - Fax:617-523-9701
Practice Address - Street 1:10 CITY HALL AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02108-4301
Practice Address - Country:US
Practice Address - Phone:617-523-9700
Practice Address - Fax:617-523-9701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0314277Medicaid