Provider Demographics
NPI:1275770208
Name:BRAINTREE MALL EYECARE
Entity Type:Organization
Organization Name:BRAINTREE MALL EYECARE
Other - Org Name:COHEN'S FASHION OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:SNOW WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:781-848-8841
Mailing Address - Street 1:250 GRANITE ST
Mailing Address - Street 2:SUITE #1019
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-2804
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:250 GRANITE ST
Practice Address - Street 2:SUITE #1019
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-2804
Practice Address - Country:US
Practice Address - Phone:781-848-4481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA3651152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty