Provider Demographics
NPI:1114055894
Name:MR. SPECS OPTICIANS, INC.
Entity Type:Organization
Organization Name:MR. SPECS OPTICIANS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:PICCOLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-592-8419
Mailing Address - Street 1:518 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01904-2717
Mailing Address - Country:US
Mailing Address - Phone:781-592-8419
Mailing Address - Fax:
Practice Address - Street 1:518 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01904-2717
Practice Address - Country:US
Practice Address - Phone:781-592-8419
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1941332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1529463Medicaid
1080310001Medicare ID - Type Unspecified