Provider Demographics
NPI:1346629805
Name:MASS OPTOMETRIC ASSOCIATES, LLC
Entity Type:Organization
Organization Name:MASS OPTOMETRIC ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, RETAIL MANAGED CARE
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-524-6615
Mailing Address - Street 1:PO BOX 417821
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-7821
Mailing Address - Country:US
Mailing Address - Phone:800-340-0129
Mailing Address - Fax:210-524-6587
Practice Address - Street 1:1201 BROADWAY
Practice Address - Street 2:STE. S223
Practice Address - City:SAUGUS
Practice Address - State:MA
Practice Address - Zip Code:01906-4274
Practice Address - Country:US
Practice Address - Phone:781-233-2073
Practice Address - Fax:781-233-1948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-29
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty