Provider Demographics
NPI:1760970503
Name:SHLOSMAN, DENIS (OD)
Entity type:Individual
Prefix:
First Name:DENIS
Middle Name:
Last Name:SHLOSMAN
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:NEWTONVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02460-1923
Mailing Address - Country:US
Mailing Address - Phone:617-964-3366
Mailing Address - Fax:857-375-6958
Practice Address - Street 1:336 WALNUT ST
Practice Address - Street 2:
Practice Address - City:NEWTONVILLE
Practice Address - State:MA
Practice Address - Zip Code:02460-1923
Practice Address - Country:US
Practice Address - Phone:617-964-3366
Practice Address - Fax:857-375-6958
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-26
Last Update Date:2025-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5287152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty