Provider Demographics
NPI:1003039082
Name:CONCORD -IMTREX INC
Entity Type:Organization
Organization Name:CONCORD -IMTREX INC
Other - Org Name:COHEN'S FASHION OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SVETLANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGOMOLOV
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICION
Authorized Official - Phone:508-651-9811
Mailing Address - Street 1:1245 WORCESTER ST
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-1515
Mailing Address - Country:US
Mailing Address - Phone:508-651-9811
Mailing Address - Fax:508-651-9814
Practice Address - Street 1:1245 WORCESTER ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-1515
Practice Address - Country:US
Practice Address - Phone:508-651-9811
Practice Address - Fax:508-651-9814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty