Provider Demographics
NPI:1487419933
Name:ESTAPA, ADAM (LDO, ABOC, NCLEC)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:ESTAPA
Suffix:
Gender:M
Credentials:LDO, ABOC, NCLEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-8621
Mailing Address - Country:US
Mailing Address - Phone:781-316-0141
Mailing Address - Fax:781-316-0141
Practice Address - Street 1:60 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-8621
Practice Address - Country:US
Practice Address - Phone:781-316-0141
Practice Address - Fax:781-316-0141
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6681156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician