Provider Demographics
NPI:1124205711
Name:RICHARD J. SYNKOSKI
Entity Type:Organization
Organization Name:RICHARD J. SYNKOSKI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:SYNKOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:508-752-6081
Mailing Address - Street 1:390 MAIN ST
Mailing Address - Street 2:SUITE 618
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-2583
Mailing Address - Country:US
Mailing Address - Phone:508-752-6081
Mailing Address - Fax:508-752-0303
Practice Address - Street 1:390 MAIN ST
Practice Address - Street 2:SUITE 618
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-2583
Practice Address - Country:US
Practice Address - Phone:508-752-6081
Practice Address - Fax:508-752-0303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2721332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
1306824768OtherINDIVIDUAL NPI
MA0334766Medicaid
MA0334766Medicaid
0486670001Medicare NSC