Provider Demographics
NPI:1114174968
Name:MASSENA OPTICS, INC.
Entity Type:Organization
Organization Name:MASSENA OPTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KIESWETTER
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:315-769-5881
Mailing Address - Street 1:55 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MASSENA
Mailing Address - State:NY
Mailing Address - Zip Code:13662-1913
Mailing Address - Country:US
Mailing Address - Phone:315-769-5881
Mailing Address - Fax:315-769-3997
Practice Address - Street 1:55 MAIN ST
Practice Address - Street 2:
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662-1913
Practice Address - Country:US
Practice Address - Phone:315-769-5881
Practice Address - Fax:315-769-3997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-23
Last Update Date:2008-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3272332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier