Provider Demographics
NPI:1013647759
Name:CONCORD OPTICAL COMPANY INC
Entity Type:Organization
Organization Name:CONCORD OPTICAL COMPANY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOURQUE
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:978-369-6707
Mailing Address - Street 1:80 THOREAU ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2458
Mailing Address - Country:US
Mailing Address - Phone:978-369-6707
Mailing Address - Fax:978-369-1880
Practice Address - Street 1:80 THOREAU ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2458
Practice Address - Country:US
Practice Address - Phone:978-369-6707
Practice Address - Fax:978-369-1880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier