Provider Demographics
NPI:1154854941
Name:MASS OPTOMETRIC PROVIDERS, PLLC
Entity Type:Organization
Organization Name:MASS OPTOMETRIC PROVIDERS, PLLC
Other - Org Name:VISIONWORKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-524-6922
Mailing Address - Street 1:PO BOX 417814
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-7814
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:344 RUSSELL ST
Practice Address - Street 2:UNIT 5
Practice Address - City:HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01035-5904
Practice Address - Country:US
Practice Address - Phone:413-584-0452
Practice Address - Fax:413-584-0382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty