Provider Demographics
NPI:1326135013
Name:ESSEX OPTICAL CORPORATION
Entity Type:Organization
Organization Name:ESSEX OPTICAL CORPORATION
Other - Org Name:PARRELLI OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:STEWART
Authorized Official - Last Name:BIRD
Authorized Official - Suffix:
Authorized Official - Credentials:RDO
Authorized Official - Phone:978-922-5996
Mailing Address - Street 1:40 ENON ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-1168
Mailing Address - Country:US
Mailing Address - Phone:978-922-5996
Mailing Address - Fax:978-922-5997
Practice Address - Street 1:40 ENON ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-1168
Practice Address - Country:US
Practice Address - Phone:978-922-5996
Practice Address - Fax:978-922-5997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1881156FC0801X, 156FX1800X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens FitterGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMA1535382Medicaid
MA0395560002Medicare NSC