Provider Demographics
NPI:1205906104
Name:MCCARRON, CHANTAL DOLLY (OD)
Entity type:Individual
Prefix:DR
First Name:CHANTAL
Middle Name:DOLLY
Last Name:MCCARRON
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 1:3 WOODLAND RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-1702
Mailing Address - Country:US
Mailing Address - Phone:781-979-0960
Mailing Address - Fax:781-979-0618
Practice Address - Street 1:3 WOODLAND RD
Practice Address - Street 2:SUITE 120
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-1702
Practice Address - Country:US
Practice Address - Phone:781-979-0960
Practice Address - Fax:781-979-0618
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003638152W00000X
VA0618002841152W00000X
WI21309-875152W00000X
FLOPC4074152W00000X
NY007646152W00000X
MA4674152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist