Provider Demographics
NPI:1609237940
Name:ELLIOTT EYE DOCTORS AND THE OPTICAL SHOPPE PC
Entity Type:Organization
Organization Name:ELLIOTT EYE DOCTORS AND THE OPTICAL SHOPPE PC
Other - Org Name:OPTICAL SHOPPE PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OD
Authorized Official - Prefix:
Authorized Official - First Name:MAKENZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:508-543-4840
Mailing Address - Street 1:25 MECHANIC ST
Mailing Address - Street 2:
Mailing Address - City:FOXBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02035-2011
Mailing Address - Country:US
Mailing Address - Phone:508-543-4840
Mailing Address - Fax:508-698-1013
Practice Address - Street 1:25 MECHANIC ST
Practice Address - Street 2:
Practice Address - City:FOXBORO
Practice Address - State:MA
Practice Address - Zip Code:02035-2011
Practice Address - Country:US
Practice Address - Phone:508-543-4840
Practice Address - Fax:508-698-1013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-15
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty