Provider Demographics
NPI:1053560706
Name:RAGHURAM, APARNA (OD, PHD)
Entity type:Individual
Prefix:DR
First Name:APARNA
Middle Name:
Last Name:RAGHURAM
Suffix:
Gender:F
Credentials:OD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LONGWOOD AVE
Mailing Address - Street 2:FEGAN 4, DEPARTMENT OF OPHTHALMOLOGY
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:617-355-6401
Mailing Address - Fax:617-730-0392
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:FEGAN 4, DEPARTMENT OF OPHTHALMOLOGY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-6401
Practice Address - Fax:617-730-0392
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4680152W00000X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics