Provider Demographics
NPI:1639368897
Name:GENERAL OPTICAL
Entity Type:Organization
Organization Name:GENERAL OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LESLILE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ARSLANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:617-864-0204
Mailing Address - Street 1:2038 MASS AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-2104
Mailing Address - Country:US
Mailing Address - Phone:617-864-0204
Mailing Address - Fax:
Practice Address - Street 1:2038 MASS AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140-2104
Practice Address - Country:US
Practice Address - Phone:617-864-0204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5197332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0867990001Medicare PIN