Provider Demographics
NPI:1568616431
Name:LOOK OPTICAL, INCORPORATED
Entity Type:Organization
Organization Name:LOOK OPTICAL, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:C
Authorized Official - Last Name:THAYER
Authorized Official - Suffix:
Authorized Official - Credentials:LDO, COT, ABOC, NCLE
Authorized Official - Phone:978-461-3937
Mailing Address - Street 1:60 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MAYNARD
Mailing Address - State:MA
Mailing Address - Zip Code:01754-2516
Mailing Address - Country:US
Mailing Address - Phone:978-461-3937
Mailing Address - Fax:978-461-3931
Practice Address - Street 1:60 MAIN ST
Practice Address - Street 2:
Practice Address - City:MAYNARD
Practice Address - State:MA
Practice Address - Zip Code:01754-2516
Practice Address - Country:US
Practice Address - Phone:978-461-3937
Practice Address - Fax:978-461-3931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6190261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service