Provider Demographics
NPI:1467561621
Name:MOODY-MCCARTHY, SONDA CAROL (OPTICIAN)
Entity Type:Individual
Prefix:MRS
First Name:SONDA
Middle Name:CAROL
Last Name:MOODY-MCCARTHY
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 W UNION ST
Mailing Address - Street 2:101
Mailing Address - City:ASHLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01721-1465
Mailing Address - Country:US
Mailing Address - Phone:508-881-4800
Mailing Address - Fax:508-881-7806
Practice Address - Street 1:25 W UNION ST
Practice Address - Street 2:101
Practice Address - City:ASHLAND
Practice Address - State:MA
Practice Address - Zip Code:01721-1465
Practice Address - Country:US
Practice Address - Phone:508-881-4800
Practice Address - Fax:508-881-7806
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA179779156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA032228801603Medicaid
MA1599062Medicaid
MA1599062Medicaid