Provider Demographics
NPI:1619473725
Name:PATRICIA L RAMANAUSKAS
Entity Type:Organization
Organization Name:PATRICIA L RAMANAUSKAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:LUCILLE
Authorized Official - Last Name:RAMANAUSKAS
Authorized Official - Suffix:
Authorized Official - Credentials:RDO
Authorized Official - Phone:781-821-0874
Mailing Address - Street 1:95 WASHINGTON ST STE 466
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-4008
Mailing Address - Country:US
Mailing Address - Phone:781-821-0874
Mailing Address - Fax:781-828-0241
Practice Address - Street 1:110 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5521
Practice Address - Country:US
Practice Address - Phone:508-565-3130
Practice Address - Fax:508-565-3243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5233156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty