Provider Demographics
NPI:1902344302
Name:PAINE, ASHLEY LAUREN (OD)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:LAUREN
Last Name:PAINE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ASHLEY
Other - Middle Name:LAUREN
Other - Last Name:BLANCHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:11 EMBASSY ROAD
Mailing Address - Street 2:APT 3
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-4636
Mailing Address - Country:US
Mailing Address - Phone:978-551-4637
Mailing Address - Fax:
Practice Address - Street 1:236 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-1495
Practice Address - Country:US
Practice Address - Phone:617-591-4949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA152W00000X
MA5222152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist