1760682967 NPI number — MASS OPTOMETRIC ASSOCIATES, PLLC

Table of content: (NPI 1760682967)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760682967 NPI number — MASS OPTOMETRIC ASSOCIATES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MASS OPTOMETRIC ASSOCIATES, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760682967
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2921 ERIE BLVD E
Provider Second Line Business Mailing Address:
C/O EMPIRE VISION CENTER , INC
Provider Business Mailing Address City Name:
SYRACUSE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13224-1430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-446-3145
Provider Business Mailing Address Fax Number:
315-445-7675

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 WASHINGTON ST
Provider Second Line Business Practice Location Address:
#3
Provider Business Practice Location Address City Name:
PEMBROKE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02359-1887
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-826-5117
Provider Business Practice Location Address Fax Number:
781-826-0954
Provider Enumeration Date:
07/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FRANKL
Authorized Official First Name:
RANDI
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
516-815-1646

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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