Provider Demographics
NPI:1538404793
Name:DEVITSKAYA, ALLA (OD)
Entity type:Individual
Prefix:DR
First Name:ALLA
Middle Name:
Last Name:DEVITSKAYA
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 1:61 N QUINSIGAMOND AVE
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-5143
Mailing Address - Country:US
Mailing Address - Phone:443-854-7983
Mailing Address - Fax:
Practice Address - Street 1:61 N QUINSIGAMOND AVE
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-5143
Practice Address - Country:US
Practice Address - Phone:443-854-7983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0872152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist