Provider Demographics
NPI:1225036734
Name:HRACH, TERESA (OD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:
Last Name:HRACH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 WARE ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-2944
Mailing Address - Country:US
Mailing Address - Phone:508-376-2539
Mailing Address - Fax:774-849-3276
Practice Address - Street 1:840 MAIN ST STE 112
Practice Address - Street 2:
Practice Address - City:MILLIS
Practice Address - State:MA
Practice Address - Zip Code:02054-1542
Practice Address - Country:US
Practice Address - Phone:508-376-2539
Practice Address - Fax:774-849-3276
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3700152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0370631Medicaid
MA0370631Medicaid
MAU28419Medicare UPIN